Rheumatoid Arthritis - Pharmacoeconomics
Abstract #296 A National Study of the Impact of Health Insurance and Managed Care Expenditures for Persons 16-64 with Musculoskeletal Conditions. E. Yelin, A. Herndorf, L. Trupin. California.
Between 1990-1996, the U.S. population of medically uninsured increased by 14-16%, while those insured by managed care plans (MCPs) increased by 50%. The investigators used the 1996 Medical Expenditures Panel Study Household Component (MEPS-HC) to investigate the impact of no insurance or insurance via an HMO, compared to patients with fee-for-service health insurance, on medical expenditures in 1996 for persons with musculoskeletal diseases. The sample size was 23,888 with oversampling of black and Hispanic populations. The analysis was limited to 2,856 persons with musculoskeletal conditions. In 1996, of those with musculoskeletal conditions, 15% had no insurance. Expenditures for each group are listed below.
| Health Insurance | Health Insurance | Kind of Health Plan | Kind of Health Plan | |
| Type of Expenditures | Present | Absent | Fee-for-Service | Managed Care |
| Ambulatory | $947 | $220 | $784 | $857 |
| Prescriptions | $537 | $183 | $507 | $502 |
| Total | $3249 | $793 | $2911 | $2824 |
Persons with no insurance reported substantially lower medical care expenditures for musculoskeletal conditions than those with insurance. However, persons with managed care plans did not experience lower expenditures than traditional fee-for-service care.
Editorial Comment: These data contradict the widely held belief that managed care plans provide significant savings in medical expenditures. More importantly, it raises concern of inadequate treatment of those individuals with musculoskeletal conditions who have no insurance.