Publication year: 2011
Source: Social Science & Medicine, In Press, Accepted Manuscript, Available online 23 August 2011
Amit, Nigam
This paper examines the impact of institutional change on patient care. Using panel data on obstetric deliveries from the state of California in the United States between 1983 and 2001, it develops and tests hypotheses predicting impacts of three features of institutional change—managed care insurance, changing professional controls and public attention to cost-control practices—on cesarean use and geographic variation in cesarean deliveries. It finds that managed care insurance promotes the diffusion of cost-effective patient care practices, reducing cesarean use and increasing variation. I found that over time, managed care patients experience continued lower use and reduced geographic variation as new…
Highlights: ► Develops and tests hypotheses predicting impacts of institutional change in American health care on patient care. ► Identifies institutional change and diffusion of cost-effective patient care practices as causes of geographic variation in medical care. ► Shows that clinical guidelines and managed care organizations can reduce health services use, diffuse new patient care practices, and standardize patient care. ► Emphasizes importance of using longitudinal data to analyze geographic variation.