Disentangling States’ Transition of Health Care Delivery and Financing Systems into Managed Care

Document Type


Presentation Date


Conference Name

Midwest Political Science Association (MPSA) Annual National Conference

Conference Location

Chicago, Illinois, USA


This paper, with a theoretical framework of policy innovation and diffusion, explore the underlying factors that lead states to transform their health care delivery and financing systems into managed care. The models take into account the impacts of states’ internal characteristics such as economic, political, institutional, and socio-demographic characteristics and external pressures on states’ decisions to adopt Medicaid managed care programs (MMCP). Five different types of MMCPs are identified based on two key characteristics – risk-transfer to managed care entities and regional coverage. The results drawn from the duration model for competing events identify several meaningful factors. Knowledge accumulated from others’ and a state's own experiences facilitates diffusion of an innovation. Cost containment motivation expedites diffusion of MMCP. States with liberal are less likely to adopt Medicaid managed care. On the other hand, size of states, the number of physicians, expansion of Medicaid program, management capacity, and neighboring states’ experience increase the probability of states’ transition, holding all others constant. In addition, the analyses discover different politics underling decision-making processes in fee-for-service-based and risk-based managed care programs.


Medicaid Managed Care Program, Policy Innovations and Diffusion, Duration Model


Other Political Science | Public Affairs, Public Policy and Public Administration

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