Evaluation of the Arizona Health Care Cost Containment System: Utilization of Medical Care Services in the Fourth and Fifth Program Years

摘要

The report presents findings concerning the utilization of medical care services in the Arizona Health Care Cost Containment System (AHCCCS) in its fourth and fifth years of operation, October 1985 through September 1987. AHCCCS is Arizona's alternative to traditional Medicaid coverage for acute medical care and has a number of innovative features that differentiate it from traditional fee-for-service Medicaid. It selects providers through a competitive bidding process under which winning bidders are paid a capitated amount (their bid rate). The State is also reimbursed on a prepaid capitated basis by the Federal Government. Under the program, beneficiaries are assigned to a particular 'gatekeeper' who manages their care. The information on service utilization used in this report is based on encounter data collected by AHCCCS from the health plans. Encounter data contain essentially the same kind of identification information about the service received as is contained in a claim (patient, provider, date of service, kind of service, diagnosis), except there is no billed amount that is linked to a payment.