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Impact of Private Equity in Healthca...

Jiao, Yang Amy,

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Impact of Private Equity in Healthcare on Medicaid Enrollees /

Record Type:	Electronic resources : Monograph/item
Title/Author:	Impact of Private Equity in Healthcare on Medicaid Enrollees // Yang Amy Jiao.
Author:	Jiao, Yang Amy,
Description:	1 electronic resource (133 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 87-03, Section: B.
Contained By:	Dissertations Abstracts International87-03B.
Subject:	Medicine. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=32271859
ISBN:	9798291566718

Impact of Private Equity in Healthcare on Medicaid Enrollees /
Jiao, Yang Amy,

Impact of Private Equity in Healthcare on Medicaid Enrollees /Yang Amy Jiao. - 1 electronic resource (133 pages)

Source: Dissertations Abstracts International, Volume: 87-03, Section: B.

Amidst the rapid expansion of private equity (PE) into healthcare, understanding how PE ownership affects access and care quality is essential for policymakers. However, little is known about its impact on Medicaid enrollees. This dissertation explores the effects of PE ownership on access and quality of care for Medicaid patients, focusing on two settings: 1) labor and delivery (L&D) services in hospitals and 2) primary care services.Chapter 2 evaluates the effects of PE hospital acquisition on L&D services for Medicaid patients. Using a staggered difference-in-differences (DiD) approach, I find that PE acquisition is associated with a 12% decrease in access to obstetric care in PE acquired hospitals (p<0.05) for Medicaid patients, with larger declines in states where Medicaid-to-commercial payment differentials are greater. There is no significant change in low-risk cesarean rates, number of procedures, length of stay, or severe maternal morbidity. While clinical quality remains unchanged, the reduction in access raises concerns about whether financial incentives from PE ownership align with the healthcare needs of vulnerable populations.Chapter 3 shifts the focus to primary care practices, investigating how PE ownership affects Medicaid patients' access to and utilization of primary care services. Following acquisitions, PE-owned practices see a 12% increase in the number of unique Medicaid patients per primary care physician per quarter (2.5 patients, p < 0.05). Evaluation and management (E&M) visits and new patient visits increased by 0.89 (5%, p<0.05) and 0.29 visits (5%, p<0.05), respectively. The percentage of E&M visits that last more than 30 minutes and the percentage of patients having specialty visits in 90 days remain unchanged, suggesting that PE ownership does not alter the treatment intensity, given that I find no evidence of patient selection based on risk scores, age, gender, or race.Chapter 4 builds on Chapter 3 by examining the impact of PE acquisition on care quality for Medicaid patients. The study evaluates several key quality measures used by the Centers for Medicare & Medicaid Services (CMS), including preventable emergency department (ED) visits, ambulatory care-sensitive condition (ACSC) hospitalizations, continuity of care, care fragmentation, and physician involvement in patient conditions. I find modest improvements in some preventive care outcomes, including a reduction in preventable ED visits (-2 percentage points, p<0.05) and ACSC-related hospitalizations (- 1.5 percentage points, p<0.05), potentially due to improved access to timely outpatient care. Continuity of care also increases slightly (2 percentage points, p<0.05), suggesting stronger patient-provider relationships. However, care fragmentation and physician involvement remain unchanged.This dissertation contributes to the growing literature on PE in healthcare by providing the first analysis of PE's impact on Medicaid patients across both hospital and primary care settings. On the one hand, PE acquisition appears to improve access to primary care and reduce certain types of avoidable acute care utilization. On the other hand, the financial pressures and cost-cutting strategies associated with PE ownership lead to reduced access to labor and delivery (L&D) services in PE-owned hospitals, despite no decline in quality of care measures. These mixed results underscore the importance of aligning financial incentives with patient outcomes and ensuring that increased access does not come at the expense of comprehensive, coordinated, and high-quality care.

English

ISBN: 9798291566718Subjects--Topical Terms:

641104
Medicine.
Subjects--Index Terms:

Health economics

Impact of Private Equity in Healthcare on Medicaid Enrollees /
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520 $a Amidst the rapid expansion of private equity (PE) into healthcare, understanding how PE ownership affects access and care quality is essential for policymakers. However, little is known about its impact on Medicaid enrollees. This dissertation explores the effects of PE ownership on access and quality of care for Medicaid patients, focusing on two settings: 1) labor and delivery (L&D) services in hospitals and 2) primary care services.Chapter 2 evaluates the effects of PE hospital acquisition on L&D services for Medicaid patients. Using a staggered difference-in-differences (DiD) approach, I find that PE acquisition is associated with a 12% decrease in access to obstetric care in PE acquired hospitals (p<0.05) for Medicaid patients, with larger declines in states where Medicaid-to-commercial payment differentials are greater. There is no significant change in low-risk cesarean rates, number of procedures, length of stay, or severe maternal morbidity. While clinical quality remains unchanged, the reduction in access raises concerns about whether financial incentives from PE ownership align with the healthcare needs of vulnerable populations.Chapter 3 shifts the focus to primary care practices, investigating how PE ownership affects Medicaid patients' access to and utilization of primary care services. Following acquisitions, PE-owned practices see a 12% increase in the number of unique Medicaid patients per primary care physician per quarter (2.5 patients, p < 0.05). Evaluation and management (E&M) visits and new patient visits increased by 0.89 (5%, p<0.05) and 0.29 visits (5%, p<0.05), respectively. The percentage of E&M visits that last more than 30 minutes and the percentage of patients having specialty visits in 90 days remain unchanged, suggesting that PE ownership does not alter the treatment intensity, given that I find no evidence of patient selection based on risk scores, age, gender, or race.Chapter 4 builds on Chapter 3 by examining the impact of PE acquisition on care quality for Medicaid patients. The study evaluates several key quality measures used by the Centers for Medicare & Medicaid Services (CMS), including preventable emergency department (ED) visits, ambulatory care-sensitive condition (ACSC) hospitalizations, continuity of care, care fragmentation, and physician involvement in patient conditions. I find modest improvements in some preventive care outcomes, including a reduction in preventable ED visits (-2 percentage points, p<0.05) and ACSC-related hospitalizations (- 1.5 percentage points, p<0.05), potentially due to improved access to timely outpatient care. Continuity of care also increases slightly (2 percentage points, p<0.05), suggesting stronger patient-provider relationships. However, care fragmentation and physician involvement remain unchanged.This dissertation contributes to the growing literature on PE in healthcare by providing the first analysis of PE's impact on Medicaid patients across both hospital and primary care settings. On the one hand, PE acquisition appears to improve access to primary care and reduce certain types of avoidable acute care utilization. On the other hand, the financial pressures and cost-cutting strategies associated with PE ownership lead to reduced access to labor and delivery (L&D) services in PE-owned hospitals, despite no decline in quality of care measures. These mixed results underscore the importance of aligning financial incentives with patient outcomes and ensuring that increased access does not come at the expense of comprehensive, coordinated, and high-quality care.
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653 $a Maternal health
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