Date of Award


Document Type

Campus Access Dissertation


Health Services and Policy Management

First Advisor

Sudha Xirasagar


This study attempted to identify the association between the burden of Medicaid Managed Care and the hospital's response to that burden in terms of the impact on patient charges. The study involved the use of a nationwide patient data set that included the most complete cost, charge and clinical data available. Procedure specific burden measures were created to operationalize the burden of Medicaid Managed Care (MMC) as the percent of MMC for each procedure of study. The dependent variable was patient charges for each procedure and was analyzed using a multilevel model that accounted for the random effect of hospital in the regression. The key independent variable of interest (Burden of MMC) was found to be significantly associated with increases in patient charges. Several covariates were also found to be significantly associated with differences in patient charges. These included hospital profit motive (cost to charge ratio), patient severity of illness (APR_SEV), discharge year, payer, geographic region of the country, discharge status and the specialty of the admitting physician. The findings, among the high cost procedures of study, were that the effect of Medicaid Managed Care on patient charges were consistent in that the greater the burden of Medicaid Managed Care, the higher the patient charges.