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On Being New to an Insurance Plan: Health Care Use Associated With the First Years in a Health Insurance Plan

Center for Health Services Research in Primary Care and Department of Family and Community Medicine, University of California, Davis, Calif

CORRESPONDING AUTHOR Peter Franks, MD Center for Health Services Research in Primary Care, Department of Family and Community Medicine, University of California, Davis 4860 Y Street, Ste 2300 Sacramento, CA 95817 pfranks{at}ucdavis.edu

BACKGROUND We wanted to compare health care utilization and costs in the first year of being in a health insurance plan with those of subsequent years.

METHODS We used claims data from an independent practitioner association (IPA)-style managed care organization in the Rochester, NY, metropolitan area from 1996 through 1999. Cross-sectional and panel analyses of up to 4 years of claims data were conducted, involving 335,547 adult patients assigned to the panels of 687 primary care physicians (internists and family physicians). Multivariate analyses, adjusting for age, sex, case mix, and socioeconomic status derived from ZIP codes, examined the relationship between the first year of health insurance and Papanicolaou tests, mammograms in women older than 40 years, physician use, avoidable hospitalization, and expenditures.

RESULTS After multivariate adjustment, the first year of insurance was associated with a higher risk of not getting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of visiting a physician, and higher expenditures, especially for testing. There was no relationship, however, between Papanicolaou test compliance and year of enrollment.

CONCLUSIONS The findings suggest there might be adverse clinical and financial implications associated with changing insurance.

Key Words: Managed care programs/utilization • insurance • preventive health services • health care costs • continuity of patient care

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