Changes in Physician Prescription Practices for Lipid Abnormalities in VA and Medicaid Populations and an Estimate of the Cost of Therapy

Date of Submission


Document Type


Degree Name

Doctor of Science in Management Systems (Sc.D.)




Margaret L. Frank

Committee Member

Steven J. Shapiro

Committee Member

Michael Morris

LC Subject Headings

Lipidoses--Treatment--United States, Managed care plans (Medical Care), Medicaid, Veterans--Medical care--United States

Call No. at the Univ. of New Haven Library

AS 36 N290 Mgmt. Syst. 1995 no.4


Medical guidelines are becoming more important in health care in the current transition to more comprehensive managed care, particularly as cost and quality of care concerns are emphasized in health care delivery organizations. The study of individual physician practices as they relate to health care organization policies is essential to understanding the optimal management of health care systems.

In June, 1993 the National Cholesterol Education Program (NCEP) expert panel published new guidelines for the treatment of abnormal lipid values. The panel broadened the use of drug therapy for patients considered at risk for coronary problems.

This study analyzed physician prescription patterns in the treatment of cholesterol lipid abnormalities in Veterans Affairs (VA) and Medicaid populations. The study included organizational aspects of how health care is delivered, the process of medical practice guidelines development and dissemination, and how physician behaviors are influenced in the organizational setting.

The results showed a higher level of preventive care in the VA than in Medicaid with an increase in lipids prescribed in the study period. Also, statin drugs showed the greatest increase over time in both systems, despite their relatively high cost. Further, the costs of lipid drugs were found to be substantially lower in the VA than in Medicaid.