Policymakers and economists often promote managed-care plans based on the assumption that they prevent the overuse of unnecessary surgical procedures or help steer patients to high-quality providers, compared to traditional fee-for-service insurance plans.
A recent study by a researcher at UT Southwestern Medical Center, however, found that in the case of one common surgical procedure, the checks and balances assumed with managed care did not improve the quality or outcome of care.
The study, published in the December issue of the American Journal of Medical Quality , examined differences in care for Medicare patients who received a carotid endarterectomy (CEA) and were enrolled in either managed-care or fee-for-service plans. In managed-care, an insurance company often acts as an intermediary between a person seeking care and the physician. A fee-for-service plan allows a person to make all health care decisions independently.
CEA is a surgical procedure to remove blockages in the neck arteries that can lead to strokes. National guidelines exist that establish the circumstances under which CEAs are likely to produce benefits for patients, and the procedure is nearly always performed electively.
Dr. Ethan Halm, chief of the William T. and Gay F. Solomon Division of General Internal Medicine at UT Southwestern and the study's lead author, used data from the New York Carotid Artery Surgery study for his current investigation. The data – with statistics on a patient pool of more than 11,400 cases – includes information on all Medicare beneficiaries who underwent a CEA between January 1989 and June 1999 in New York State.