Do For-profit health plans restrict access to high-cost procedures?

Question

Do for-profit health plans restrict access to high-cost procedures compared with not-for-profit health plans?

Study design

Cohort study.

Main results

In unadjusted analyses, for-profit health plan beneficiaries had higher rates of all high-cost procedures than not-for-profit health plan beneficiaries; the difference was significant for 4 out of 12 procedures (see Table 1). Rates of usage remained higher in for-profit plans after adjustment for participants’ sociodemographic factors, county of residence, and health plan characteristics (see Table 1).

Table 1 Difference in rates of high-cost procedures between for-profit plans and not-for-profit plans.
Procedure	Difference per 10,000 beneficiaries (95% CI)
	Unadjusted	Adjusted for sociodemographic factors∗	Adjusted for health plan characteristics†, sociodemographic	Adjusted for county of residence‡, sociodemographic factors, health plan characteristics
Hysterectomy	2.6 (−0.3 to 5.5)	2.7 (−0.2 to 5.6)	2.2 (−1.0 to 5.4)	2.5 (0.6 to 4.3)§
Prostatectomy	4.3 (−1.4 to 10.1)	3.8 (−1.9 to 9.6)	3.3 (−3.1 to 9.8)	6.3 (0.2 to 12.3)§
Closed cholecystectomy	5.8 (−0.2 to 11.9)	6.1 (0.1 to 12.1)§	7.0 (0.4 to 13.6)§	7.7 (3.4 to 11.9)§
Open cholecystectomy	0.8 (−1.6 to 3.1)	0.8 (−1.5 to 3.2)	0.6 (−2.1 to 3.3)	1.9 (−0.1 to 3.8)
Partial colectomy	4.0 (−1.0 to 9.0)	4.4 (−0.6 to 9.4)	6.0 (0.3 to 11.6)§	8.4 (4.8 to 12.0)§
Reduction of femur fracture	2.6 (−2.9 to 8.2)	6.0 (0.5 to 11.4)§	5.3 (−0.9 to 11.4)	6.4 (1.1 to 11.6)§
Total knee replacement	5.1 (−1.0 to 11.2)	5.1 (−0.9 to 11.2)	5.7 (−0.9 to 12.4)	8.3 (3.1 to 13.6)§
Total hip replacement	2.4 (−5.1 to 10.0)	3.0 (−4.5 to 10.5)	2.3 (−6.2 to 10.9)	5.4 (0.8 to 9.9)§
Cardiac catheterisation	31.6 (9.0 to 54.2)§	31.0 (8.7 to 53.3)§	15.2 (−9.2 to 39.5)	26.5 (14.1 to 38.9)§
Coronary artery bypass grafting	10.3 (2.5 to 15.1)§	10.7 (3.1 to 18.3)§	7.6 (−1.0 to 16.2)	6.3 (0 to 12.7)§
Percutaneous transluminal coronary angioplasty	8.5 (1.0 to 16.1)§	9.0 (1.6 to 16.4)§	6.0 (−2.3 to 14.3)	2.6 (−2.8 to 8.0)
Carotid endarterectomy	5.4 (1.0 to 9.9)§	6.0 (1.6 to 10.4)§	2.3 (−2.5 to 7.1)	4.2 (1.1 to 7.3)§
∗Sociodemographic factors: sex, age, race or ethnic group, income, education, rural or urban residence, Medicaid eligibility. †Health plan characteristics: years in operation, number of beneficiaries, health plan model type (independent practice association, network, mixed, group or staff). ‡Differences weighted according to county of residence of beneficiaries. §$\text{P<0.05}$.

Authors’ conclusions

There is no evidence that for-profit heath plan beneficiaries are less likely to receive high-cost procedures than not-for-profit health plan beneficiaries.