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The Politics of Medicaid Contracting and Privatization

Randall, David J.
http://rave.ohiolink.edu/etdc/view?acc_num=kent1337598681

Abstract Details

2012, PHD, Kent State University, College of Arts and Sciences / Department of Political Science.
State Medicaid programs transfer over $100 billion to private firms to manage the health care needs of beneficiaries every year. As a result of state policy choices, there is a great deal of variation among the states in the scope and use of managed care organizations to serve state Medicaid populations. This research answers questions about what factors help to explain the variations among states; with a specific emphasis on both the role of interest group populations and bureaucratic capacity. The questions posed are answered utilizing pooled, cross-sectional time series analysis from 1997 to 2007 to test the relationship between Medicaid managed care policy choices and a variety of political, economic, demographic and governmental control variables. In addition, a four state case study analysis was conducted with similar policy players in each state that utilizes content analysis software to examine transcribed interview response variations about state Medicaid privatization efforts. The findings from the quantitative models suggest that interest groups play an important role in explaining why states choose to use commercial for-profit managed care arrangements. The models also find that states with higher levels of bureaucratic capacity tend to rely less on the use of all forms of managed care in Medicaid contracting, and that state specific managed care markets are positively related to state managed care policy choices. The four state qualitative interviews confirm the accuracy of the statistical analysis and further provide a narrative explaining why states favor one type of Medicaid managed care use. In addition, the interviews clarify how strong interest group communities and diminished bureaucratic capacity explain a state’s policy choices. The findings contribute to the state policy and politics literature and health policy making about the role of bureaucracy and interest groups and are generalizable to other state policy venues.
Renee Johnson, J (Committee Chair)
Daniel Hawes (Committee Member)
Christopher Banks (Committee Member)
Stephen Parente, T (Committee Member)
Susan Roxburgh (Committee Member)
184 p.
Health Care; Health Care Management; Political Science; Public Administration; Public Health; Public Policy
Medicaid; entitlements; interest groups; state policymaking; state bureaucracy; bureaucratic capacity; contracting; privatization; health policy; managed care

Recommended Citations

Citations

  • Randall, D. J. (2012). The Politics of Medicaid Contracting and Privatization [Doctoral dissertation, Kent State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=kent1337598681

    APA Style (7th edition)

  • Randall, David. The Politics of Medicaid Contracting and Privatization. 2012. Kent State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=kent1337598681.

    MLA Style (8th edition)

  • Randall, David. "The Politics of Medicaid Contracting and Privatization." Doctoral dissertation, Kent State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=kent1337598681

    Chicago Manual of Style (17th edition)

kent1337598681
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© 2012, all rights reserved.
This open access ETD is published by Kent State University and OhioLINK.