Do transportation brokerage services decrease expenditures and improve health outcomes of Medicaid children?
- Presenter:
Chair: Catherine McLaughlin; Discussant: Jenny Kenney Tue June 6, 2006 8:00-9:30 Room 226
Research Objective: To help poor or disabled patients with transportation needs, Medicaid pays for non-emergency medical transportation (NEMT). Tight state budgets and rising Medicaid costs have prompted states to find efficient way of providing the mandatory NEMT services. Twenty-one states now contract with private brokerage companies, which coordinate and finance all service delivery under capitated payments. This study analyzes the effect of transportation brokerage services on Medicaid beneficiaries’ access to care.
Study Design: The study uses retrospective data analysis with a quasi-experimental design. Georgia implemented statewide transportation brokerage services in October 1997. We specified a 21-month pre- and a 21-month post-period using four calendar years of Georgia Medicaid Eligibility and Claims Data, 1996-1999. We use two-part models to predict the effect of transportation brokerage services on monthly Medicaid expenditures, controlling for personal characteristics and month. The dependent variables of interest are total, inpatient, and outpatient Medicaid expenditures. Total expenditures are the sum of all types of expenditures except transportation expenditures.
Population Studied: The study sample is a 20% random sample of children with asthma in Georgia. We identified children with asthma using ICD-9 diagnosis codes and national drug codes. The final study sample had 938,141 observations on 42,157 children at the person-month level. Inpatient, outpatient, and emergency room expenditures are analyzed.
Principal Findings: The shift to transportation brokerage services decreased the probability of any inpatient expenditures by 1.9 percentage points (from a mean of 2 percent) and the probability of outpatient expenditures by 7.4 percentage points (mean of 28 percent). The monthly expenditures per person per month also decreased by $77.28 for inpatient and by $34.35 for outpatient services. Separate analysis for children age 1-2 and age 3-18 revealed that the bulk of savings are from younger children. Incremental effects of per person per month expenditures are statistically significant using bootstrapped standard errors. The probability of any emergency room use decreased by 1.1 percentage points (mean of 6.7 percent), but the decreased emergency room expenditures were not statistically significant. The probability of any emergency room use due to asthma attack is decreased by .2 percentage points (mean of .8 percent).
Conclusions: Transportation brokerage services are associated with an overall decrease in inpatient and outpatient Medicaid expenditures and the probability of using Medicaid services. A larger decrease in inpatient expenditures is offset by a relatively smaller decrease in outpatient expenditures due to greater number of outpatient services users than inpatient services users. Decreased Medicaid expenditures are cost effective if beneficiaries’ health is not compromised. The decreased probability of emergency room visits due to asthma attack provides some evidence that health outcomes for Medicaid children with asthma improved with transportation brokerage services.
