Forced Health-Plan Switches Have Adverse Affect on Patients

Research Shows Less Prevention, Higher Costs and More Avoidable Hospitalizations Associated with First Year in an Insurance Plan

Contact:  
Angela Lower
Annals of Family Medicine
(800) 274-2237 Ext. 5224 or (913) 906-6253
alower@aafp.org

LEAWOOD, Kan. - With health insurance premiums on the rise and insurance turnover at an all-time high, there is increasing concern about the possible adverse clinical and financial implications associated with changing insurance plans.  A new study published in the September/October issue of Annals of Family Medicine validates these concerns with findings suggesting that the first year in an insurance plan is associated with less prevention, a higher risk of avoidable hospitalization and higher expenditures, especially for testing.

"When coupled with studies showing decreased patient satisfaction with forced health-plan switches, our findings indicate that there are likely pervasive adverse consequences of the frequent re-bidding of insurance contracts by employers," commented the study's lead author, Peter Franks, M.D., from the University of California, Davis.

Discontinuity in health insurance is a growing phenomenon in the United States.  According to background information provided in the study, recent research from the Center for Studying Health System Change found that one out of six consumers with private coverage changed health plans over a one-year period, with 68 percent of those changes due to either employers changing plan offerings or individuals switching jobs. The study was based on a household survey conducted between 1996 and 1997.

Recognizing the prevalence and possible costs of discontinuity, Franks and colleagues set out to assess the impact of changing insurance by comparing health-care indicators for people newly enrolled in a health plan with those in subsequent years of being insured in the same health plan. Using a multivariate analysis, the researchers analyzed four years of claims data involving 335,547 adult patients enrolled in the largest managed care organization in the Rochester, N.Y., area to determine the relationship between the first year of health insurance and a number of health-care indicators, including whether women received a PAP test, whether women over 40 had a mammogram, whether members had a physician visit, whether members had an avoidable hospitalization and members' health-care expenditures.

The researchers found that the first year of insurance was associated with 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. They found no significant relationship between year of enrollment and the likelihood of receiving a PAP test. The authors surmise that the absence of effect for PAP tests contrasted with the effect for mammograms because PAP tests may be a more established part of women's health care and a routine that patients carry with them from one insurance status to the next more easily than getting mammograms

The researchers found that adverse effects, including less prevention, higher costs and more avoidable hospitalizations, lasted up to three years from initial enrollment in a health plan.

The complete study can be accessed on the Annals of Family Medicine Web site at www.annfammed.org.  Access to this and other articles contained in the journal is free of charge.

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Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care discipline.  Launched in May 2003, the journal is sponsored by six family medical organizations, including the American Academy of Family Physicians, the American Board of Family Practice, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the North American Primary Care Research Group.  The journal is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials.  A board of directors with representatives from each of the sponsoring organizations oversees Annals. Complete editorial content and interactive discussion groups can be accessed free of charge on the journal's Web site, www.annfammed.org.