Contract No.: 100-03-0017 (HHSP2332008000002T)
MPR Reference No.: 6547-400.

Debra Lipson
Margaret Colby
Tim Lake
Su Liu
Sarah Turchin

Submitted to:
U.S. Dept. of Health and Human Services
Asst. Secretary for Planning and Evaluation
Hubert H. Humphrey Bldg.
200 Independence Ave., SW
Washington, DC 20201

Submitted by:
Mathematica Policy Research, Inc.
600 Maryland Ave., SW, Suite 550
Washington, DC 20024-2512
Telephone: (202) 484-9220
Facsimile: (202) 863-1763

Project Officer:
Rose Chu

Project Director:
Debra J. Lipson

ABSTRACT

This review synthesizes relevant studies, assesses alternative measures and methods for comparing state Medicaid costs and outcomes, and draws lessons to guide approaches to defining and measuring state Medicaid spending efficiency. It reviews studies on the definition of efficiency for the Medicaid program, different ways of measuring Medicaid spending and costs, and potential indicators of quality, access, and other outcomes.

Material contained in this publication is in the public domain and may be reproduced, fully or partially, without permission of the Federal Government. The courtesy of attribution is requested. The recommended citation follows:

Office of Health Policy, ASPE(2009) Defining and Measuring State Medicaid Spending Efficiency: A Literature Review
Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.

_{Skip contents}

Table of Contents

• Preface
• Executive Summary
  • Definition of Efficiency for the Medicaid Program
  • Measuring Medicaid Spending and Costs
  • Questions and Issues for Measuring Costs
  • Measuring Quality, Access, and Other Outcomes
  • Questions and Issues for Measuring Quality and Access to Care
  • Scoring, Ranking, and Benchmarking
  • Questions and Issues for Benchmarking and Scoring
  • Next Steps
    
    
• Chapter I Introduction
  
  
• Chapter II Defining and Measuring Efficiency in Health Care and the Medicaid Program
  • Definitions of Health Care Efficiency
  • Efficiency Measures
  • How to Define and Measure Medicaid Efficiency?
    
    
• Chapter III Measuring Medicaid Spending and Costs
  • Analyzing Medicaid Costs by Enrollee Groups
  • Analyzing Medicaid Costs by Service Categories and Limitations for Medicaid Managed Care
  • Factors Affecting Variation in State Medicaid Health Care Expenditures--To Adjust or Not?
  • General factors affecting variation in per capita state health expenditures
  • Table III.1. Potential Adjustment Factors
  • State Medicaid Program Design Leads to Differences in Per Enrollee Spending
  • Conclusions and Recommendations
    
    
• Chapter IV Measuring Medicaid Quality, Access, and Other Outcomes
• Current Quality and Access Measures
• Medicaid-Specific Quality and Access Measures
• Conclusions and Recommendations
• Chapter V Scoring, Ranking, and Benchmark-Setting
• Framework for Ranking, Developing Performance Categories, and Establishing Benchmarks
• Previous Rankings of State Medicaid Programs
• How to Combine and Present Cost and Outcome Indicators
• Figure V.1. The Relationship Between Medicare Spending and Quality of Care, by State, 2004
• Setting Benchmarks
• Measure stability and Statistical Significance
• Conclusions and Recommendations
  
  
• References
  
  
• Appendix ALiterature Review Sources, Methodology, and Summary Table
• Searches for pertinent articles
• Rapid review of articles to select the most relevant
• Thorough review and coding of most relevant articles
• Appendix B Data Sources
• Data Sources for Calculating Medicaid Expenditures
• Data Sources for Adjusting Costs for State Health Care Status

How to Obtain a Printed Copy

This report is available on the Internet at:
http://aspe.hhs.gov/health/reports/09/medeff/

Printer friendly version in PDF format (62 pages)
[Free PDF reader ]

How to obtain a printed copy

Where to?

Contents

Home Pages:
Office of Health Policy
Assistant Secretary for Planning and Evaluation (ASPE)
U.S. Department of Health and Human Services (HHS)

_{Last updated:  07/23/2009}