title: Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations.
abstract: OBJECTIVE
  Reducing unnecessary tests and treatments is a potentially promising approach for improving the value of health care. However, relatively little is known about whether insurance type or local practice patterns are associated with delivery of low-value care.
  
  
  OBJECTIVE
  To compare low-value care in the Medicaid and commercially insured populations, test whether provision of low-value care is associated with insurance type, and assess whether local practice patterns are associated with the provision of low-value care.
  
  
  METHODS
  This cross-sectional study of claims data from the Oregon Division of Medical Assistance Programs and the Oregon All-Payer All-Claims database included Medicaid and commercially insured adults aged 18 to 64 years. The study period was January 1, 2013, through December 31, 2013.
  
  
  METHODS
  Low-value care was assessed using 16 claims-based measures. Logistic regression was used to test the association between Medicaid vs commercial insurance coverage and low-value care and the association between Medicaid and commercial low-value care rates within primary care service areas (PCSAs).
  
  
  RESULTS
  This study included 286 769 Medicaid and 1 376 308 commercial enrollees in 2013. Medicaid enrollees were younger (167 847 [58.5%] of Medicaid enrollees were aged 18-34 years vs 505 628 [36.7%] of those with commercial insurance) but generally had worse health status compared with those with commercial insurance. Medicaid enrollees were also more likely to be female (180 363 [62.9%] vs 702 165 [51.0%]) and live in a rural area (120 232 [41.9%] vs 389 964 [28.3%]). A total of 10 304 of 69 338 qualifying Medicaid patients (14.9%; 95% CI, 14.6%-15.1%) received at least 1 low-value service during 2013; the corresponding rate for commercially insured patients was 35 739 of 314 023 (11.4%; 95% CI, 11.3%-11.5%). No consistent association was found between insurance type and low-value care. Compared with commercial patients, Medicaid patients were more likely to receive low-value care for 10 measures and less likely to receive low-value care for 5 others. For 7 of 11 low-value care measures, Medicaid patients were significantly more likely to receive low-value care if they resided in a PCSA with a higher rate of low-value care for commercial patients.
  
  
  CONCLUSIONS
  Oregon Medicaid and commercially insured patients received moderate amounts of low-value care in 2013. No consistent association was found between insurance type and low-value care. However, Medicaid and commercial rates of low-value care were associated with one another within PCSAs. Low-value care may be more closely related to local practice patterns than to reimbursement generosity or insurance benefit structures.
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Charlesworth
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
authors.forename: Thomas H A
authors.initials: TH
authors.lastname: Meath
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Schwartz
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland3Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
mesh_terms: D000328:Adult; D003132:Commerce / Q000191:economics; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States