Factors and effects of the termination of Medi-Cal contracts among California hospitals.

摘要

Medi-Cal is California's version of Medicaid, a public health insurance program funded by both federal and state governments for people who are poor and disabled. Recent Medi-Cal annual reports show an increasing number of Medi-Cal contract terminations between general acute care hospitals and Medi-Cal. These terminations are expected to affect Medi-Cal patients' access to inpatient services and adjacent hospitals. Past studies focused more on the interaction between hospitals and private health insurance plans, and gave less attentions to hospitals' relationships with public insurances. Using longitudinal hospital datasets from California, my research aims to explore three research questions: (1) why do hospitals terminate their contracts with Medi-Cal? (2) Will a hospital's financial health (e.g., operating margin) be improved after its Medi-Cal contract termination? (3) To what extent will a hospital's Medi-Cal contract termination affect other hospitals? I identify 65 out of 223 general acute care hospitals (30%) terminated their contracts with Medi-Cal between 1997 and 2010. The antecedents to hospitals' Medi-Cal contract terminations are more comprised of a hospital' characteristics than market or regional characteristics, specifically hospitals' financial status, such as the percentage of Medi-Cal patients, operating margin, and case mix index. After hospitals' termination, the percentage of Medi-Cal patients decrease significantly; operating margin and case mix index were only improved significantly when the termination effect is considered invariant after termination. For spillover effect, I only observe that hospitals have an increasing percentage of Medi-Cal patients after adjacent hospitals' contract termination, however, a hospital's decision on contract termination, operating margin, and case mix index are not affected by adjacent hospitals' contract termination. As the Patient Protection and Affordable Care Act (PPACA) will be enacted in 2014, individuals will be forced to have health insurance and Medi-Cal will cover more uninsured people near poverty. My results may help policymakers consider the antecedents and consequences of providers' termination of public contracts, and seek more effective strategies that can balance increasing coverage and improving the access to care under budgetary constraints.