Access to Care: How Much Difference Does Medicaid Make?

Health Affairs

Volumn 17, Issue 3, 1998, Pages 169-180

  Berk, Marc L ^a   Schur, Claudia L ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CHILD; CHILD HEALTH CARE; ECONOMICS; EPIDEMIOLOGY; FEMALE; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HUMAN; INSURANCE; MALE; MEDICAID; METHODOLOGY; MULTIVARIATE ANALYSIS; STATISTICS; UNITED STATES;

ADULT; CHILD; CHILD HEALTH SERVICES; FEMALE; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE COVERAGE; MALE; MEDICAID; MULTIVARIATE ANALYSIS; STATE HEALTH PLANS; UNITED STATES;

EID: 0032061646     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.3.169     Document Type: Article

References (32)

1. U.S. General Accounting Office, Medicaid: Sustainability of Low 1996 Spending Growth Is Uncertain, GAO/HEHS-97-128 (Washington: GAO, 1996).
2. M.L. Rosenbach, "The Impact of Medicaid on Physician Use by Low-Income Children," American Journal of Public Health 79, no. 9 (1989): 1220-1226; M. Chen and C.S. Lyttle, "Multivariate Analysis of Access to Care," in Ambulatory Care and Insurance Coverage in an Era of Constraint, ed. R.M. Andersen et al. (Chicago: Pluribus Press, 1987), 75-95; G.R. Wilensky and M.L. Berk, "Health Care, the Poor, and the Role of Medicaid," Health Affairs (Fall 1982): 93-100; M.S. Marquis and S.H. Long, "Reconsidering the Effect of Medicaid on Health Services Use," Health Services Research 30, no. 6 (1996): 791-808; and J.S. Weissman and A.M. Epstein, Falling through the Safety Net: Insurance Status and Access to Health Care (Baltimore: Johns Hopkins University Press, 1994).
3. M.L. Rosenbach, "The Impact of Medicaid on Physician Use by Low-Income Children," American Journal of Public Health 79, no. 9 (1989): 1220-1226; M. Chen and C.S. Lyttle, "Multivariate Analysis of Access to Care," in Ambulatory Care and Insurance Coverage in an Era of Constraint, ed. R.M. Andersen et al. (Chicago: Pluribus Press, 1987), 75-95; G.R. Wilensky and M.L. Berk, "Health Care, the Poor, and the Role of Medicaid," Health Affairs (Fall 1982): 93-100; M.S. Marquis and S.H. Long, "Reconsidering the Effect of Medicaid on Health Services Use," Health Services Research 30, no. 6 (1996): 791-808; and J.S. Weissman and A.M. Epstein, Falling through the Safety Net: Insurance Status and Access to Health Care (Baltimore: Johns Hopkins University Press, 1994).
4. M.L. Rosenbach, "The Impact of Medicaid on Physician Use by Low-Income Children," American Journal of Public Health 79, no. 9 (1989): 1220-1226; M. Chen and C.S. Lyttle, "Multivariate Analysis of Access to Care," in Ambulatory Care and Insurance Coverage in an Era of Constraint, ed. R.M. Andersen et al. (Chicago: Pluribus Press, 1987), 75-95; G.R. Wilensky and M.L. Berk, "Health Care, the Poor, and the Role of Medicaid," Health Affairs (Fall 1982): 93-100; M.S. Marquis and S.H. Long, "Reconsidering the Effect of Medicaid on Health Services Use," Health Services Research 30, no. 6 (1996): 791-808; and J.S. Weissman and A.M. Epstein, Falling through the Safety Net: Insurance Status and Access to Health Care (Baltimore: Johns Hopkins University Press, 1994).
5. M.L. Rosenbach, "The Impact of Medicaid on Physician Use by Low-Income Children," American Journal of Public Health 79, no. 9 (1989): 1220-1226; M. Chen and C.S. Lyttle, "Multivariate Analysis of Access to Care," in Ambulatory Care and Insurance Coverage in an Era of Constraint, ed. R.M. Andersen et al. (Chicago: Pluribus Press, 1987), 75-95; G.R. Wilensky and M.L. Berk, "Health Care, the Poor, and the Role of Medicaid," Health Affairs (Fall 1982): 93-100; M.S. Marquis and S.H. Long, "Reconsidering the Effect of Medicaid on Health Services Use," Health Services Research 30, no. 6 (1996): 791-808; and J.S. Weissman and A.M. Epstein, Falling through the Safety Net: Insurance Status and Access to Health Care (Baltimore: Johns Hopkins University Press, 1994).
6. M.L. Rosenbach, "The Impact of Medicaid on Physician Use by Low-Income Children," American Journal of Public Health 79, no. 9 (1989): 1220-1226; M. Chen and C.S. Lyttle, "Multivariate Analysis of Access to Care," in Ambulatory Care and Insurance Coverage in an Era of Constraint, ed. R.M. Andersen et al. (Chicago: Pluribus Press, 1987), 75-95; G.R. Wilensky and M.L. Berk, "Health Care, the Poor, and the Role of Medicaid," Health Affairs (Fall 1982): 93-100; M.S. Marquis and S.H. Long, "Reconsidering the Effect of Medicaid on Health Services Use," Health Services Research 30, no. 6 (1996): 791-808; and J.S. Weissman and A.M. Epstein, Falling through the Safety Net: Insurance Status and Access to Health Care (Baltimore: Johns Hopkins University Press, 1994).
7. S.H. Long and M.S. Marquis, Universal Health Insurance and Uninsured People: Effects on Use and Cost (Washington: RAND, August 1994); P.F. Short, L.J. Cornelius, and D.E. Goldstone, "Health Insurance of Minorities in the United States," Journal of Health Care for the Poor and Underserved 1 (1990): 9-30; S.H. Long and J. Rodgers, The Effects of Being Uninsured on Health Care Service Use: Estimates from the Survey of Income and Program Participation, SIPP Working Paper Series no. 9012 (Washington: U.S. Bureau of the Census, 1990); and H.E. Freeman et al., "Americans Report on Their Access to Health Care," Health Affairs (Spring 1987): 6-18.
8. S.H. Long and M.S. Marquis, Universal Health Insurance and Uninsured People: Effects on Use and Cost (Washington: RAND, August 1994); P.F. Short, L.J. Cornelius, and D.E. Goldstone, "Health Insurance of Minorities in the United States," Journal of Health Care for the Poor and Underserved 1 (1990): 9-30; S.H. Long and J. Rodgers, The Effects of Being Uninsured on Health Care Service Use: Estimates from the Survey of Income and Program Participation, SIPP Working Paper Series no. 9012 (Washington: U.S. Bureau of the Census, 1990); and H.E. Freeman et al., "Americans Report on Their Access to Health Care," Health Affairs (Spring 1987): 6-18.
9. S.H. Long and M.S. Marquis, Universal Health Insurance and Uninsured People: Effects on Use and Cost (Washington: RAND, August 1994); P.F. Short, L.J. Cornelius, and D.E. Goldstone, "Health Insurance of Minorities in the United States," Journal of Health Care for the Poor and Underserved 1 (1990): 9-30; S.H. Long and J. Rodgers, The Effects of Being Uninsured on Health Care Service Use: Estimates from the Survey of Income and Program Participation, SIPP Working Paper Series no. 9012 (Washington: U.S. Bureau of the Census, 1990); and H.E. Freeman et al., "Americans Report on Their Access to Health Care," Health Affairs (Spring 1987): 6-18.
10. S.H. Long and M.S. Marquis, Universal Health Insurance and Uninsured People: Effects on Use and Cost (Washington: RAND, August 1994); P.F. Short, L.J. Cornelius, and D.E. Goldstone, "Health Insurance of Minorities in the United States," Journal of Health Care for the Poor and Underserved 1 (1990): 9-30; S.H. Long and J. Rodgers, The Effects of Being Uninsured on Health Care Service Use: Estimates from the Survey of Income and Program Participation, SIPP Working Paper Series no. 9012 (Washington: U.S. Bureau of the Census, 1990); and H.E. Freeman et al., "Americans Report on Their Access to Health Care," Health Affairs (Spring 1987): 6-18.
11. R.J. Blendon et al., "Medicaid Beneficiaries and Health Reform," Health Affairs (Spring 1993): 132-143; R.L. Bashshur, R.K. Homan, and D.G. Smith, "Beyond the Uninsured: Problems in Access to Care," Medical Care 32, no. 5 (1994): 409-419; and D. Rowland, "Medicaid at 30: New Challenges for the Nation's Health Safety Net," Journal of the American Medical Association 274, no. 3 (1995): 271-273.
12. R.J. Blendon et al., "Medicaid Beneficiaries and Health Reform," Health Affairs (Spring 1993): 132-143; R.L. Bashshur, R.K. Homan, and D.G. Smith, "Beyond the Uninsured: Problems in Access to Care," Medical Care 32, no. 5 (1994): 409-419; and D. Rowland, "Medicaid at 30: New Challenges for the Nation's Health Safety Net," Journal of the American Medical Association 274, no. 3 (1995): 271-273.
13. R.J. Blendon et al., "Medicaid Beneficiaries and Health Reform," Health Affairs (Spring 1993): 132-143; R.L. Bashshur, R.K. Homan, and D.G. Smith, "Beyond the Uninsured: Problems in Access to Care," Medical Care 32, no. 5 (1994): 409-419; and D. Rowland, "Medicaid at 30: New Challenges for the Nation's Health Safety Net," Journal of the American Medical Association 274, no. 3 (1995): 271-273.
14. C.R. Corey and H.E. Freeman, "Use of Telephone Interviewing in Health Care Research," Part I, Health Services Research (April 1990): 129-144; J.T. Massey, "An Overview of Telephone Coverage," in Telephone Survey Methodology, ed. R.M. Groves et al. (New York: John Wiley and Sons, 1988), 3-6; and L.A. Aday, Designing and Conducting Health Surveys (San Francisco: Jossey-Bass, 1996).
15. C.R. Corey and H.E. Freeman, "Use of Telephone Interviewing in Health Care Research," Part I, Health Services Research (April 1990): 129-144; J.T. Massey, "An Overview of Telephone Coverage," in Telephone Survey Methodology, ed. R.M. Groves et al. (New York: John Wiley and Sons, 1988), 3-6; and L.A. Aday, Designing and Conducting Health Surveys (San Francisco: Jossey-Bass, 1996).
16. C.R. Corey and H.E. Freeman, "Use of Telephone Interviewing in Health Care Research," Part I, Health Services Research (April 1990): 129-144; J.T. Massey, "An Overview of Telephone Coverage," in Telephone Survey Methodology, ed. R.M. Groves et al. (New York: John Wiley and Sons, 1988), 3-6; and L.A. Aday, Designing and Conducting Health Surveys (San Francisco: Jossey-Bass, 1996).
17. Aday, Designing and Conducting Health Surveys; and R.M. Groves, Survey Errors and Survey Costs (New York: John Wiley and Sons, 1989).
18. Aday, Designing and Conducting Health Surveys; and R.M. Groves, Survey Errors and Survey Costs (New York: John Wiley and Sons, 1989).
19. M.L. Berk and C.L. Schur, "Measuring Access to Care: Improving Information for Policymakers," Health Affairs (January/February 1998): 180-186.
20. Respondents with both private insurance and Medicaid were classified as having private coverage. Persons who reported private coverage but who had listed a "single-purpose" plan (for example, vision or dread disease) on the earlier NHIS interview were not included in the private category. After assignment of insurance status, unweighted sample sizes by insurance category were as follows: 2,239 persons with private insurance, 282 with Medicaid or other public coverage (not including Medicare or military coverage), and 415 persons who were uninsured Those with Medicare or military coverage (forty-one and fifty-five observations, respectively) were excluded from the analysis.
21. M.S. Marquis and S.H. Long, "The Uninsured Access Gap: Narrowing the Estimates," Inquiry (Winter 1994/95): 405-414.
22. Standard errors were computed with SUDAAN, which uses the Taylor series linearization method to account for the complex survey design. Tests of statistical significance were used to assess whether differences in population estimates exist at specified levels of confidence. Only differences significant at the .05 level are discussed in the text. To control for other confounding factors that influence access to health care, regression analyses were conducted as well. For the two dichotomous dependent variables, we used the SUDAAN procedure LOGISTIC to fit logistic regression models to binary data, estimating odds ratios and confidence levels for the parameters. For the physician visits equation, we used a negative binomial model based on a Poisson distribution. See J. Hausman, B. Hall, and Z. Griliches, "Econometric Models for Count Data with an Application to the Patents-R&D Relationship," Econometrica 52, no. 4 (1984): 909-938; and W.H. Green, Econometric Analysis (New York: Macmillan, 1990). The Poisson regression model, in contrast to a linear model, allows us to improve on the estimation by accounting for the characteristics found in the distribution of visits; specifically, we observe a large number of zeros, a large number of small values, and a variable that is discrete in nature. Although this model better reflects the observed distribution of visits, the estimation program does not allow for appropriate estimation of standard errors given the complex survey design. Because standard errors are understated, we apply a stricter test when interpreting results, considering as significant only those coefficients that are different from zero at a 99 percent confidence interval.
23. G.L. Maddox and E.B. Douglass, "Self-Assessment of Health: A Longitudinal Study of Elderly Subjects," Journal of Health and Social Behavior 14, no. 1 (1973): 87-93; O. Lundberg and K. Manderbacka, "Assessing Reliability of a Measure of Self-Rated Health," Scandinavian Journal of Social Medicine 24, no. 3 (1996): 218-224; and M. Gold, P. Franks, and P. Erickson, "Assessing the Health of the Nation: A Predictive Validity of Preference-Based Measure and Self-Rated Health," Medical Care 34, no. 2 (1996): 163-177.
24. G.L. Maddox and E.B. Douglass, "Self-Assessment of Health: A Longitudinal Study of Elderly Subjects," Journal of Health and Social Behavior 14, no. 1 (1973): 87-93; O. Lundberg and K. Manderbacka, "Assessing Reliability of a Measure of Self-Rated Health," Scandinavian Journal of Social Medicine 24, no. 3 (1996): 218-224; and M. Gold, P. Franks, and P. Erickson, "Assessing the Health of the Nation: A Predictive Validity of Preference-Based Measure and Self-Rated Health," Medical Care 34, no. 2 (1996): 163-177.
25. G.L. Maddox and E.B. Douglass, "Self-Assessment of Health: A Longitudinal Study of Elderly Subjects," Journal of Health and Social Behavior 14, no. 1 (1973): 87-93; O. Lundberg and K. Manderbacka, "Assessing Reliability of a Measure of Self-Rated Health," Scandinavian Journal of Social Medicine 24, no. 3 (1996): 218-224; and M. Gold, P. Franks, and P. Erickson, "Assessing the Health of the Nation: A Predictive Validity of Preference-Based Measure and Self-Rated Health," Medical Care 34, no. 2 (1996): 163-177.
26. M.L. Berk, C.L. Schur, and J.C. Cantor, "Ability to Obtain Health Care: Recent Estimates from the Robert Wood Johnson Foundation National Access to Care Survey," Health Affairs (Fall 1995): 139-146.
27. Full regression results can be obtained from the authors at Project HOPE Center for Health Affairs, Suite 600, 7500 Old Georgetown Road, Bethesda, Maryland 20814.
28. Cathy Schoen and colleagues reported similar findings. See C. Schoen et al., "Insurance Matters for Low-Income Adults: Results from a Five-State Survey," Health Affairs (September/October 1997): 163-171.
29. T. Mark and C. Mueller, "Access to Care in HMOs and Traditional Insurance Plans," Health Affairs (Winter 1996): 81-87.
30. L. Summer, S. Parrott, and C. Mann, Millions of Uninsured and Underinsured Children Are Eligible for Medicaid (Washington: Center on Budget and Policy Priorities, 9 December 1996).
31. A.B. Bindman et al., "Preventable Hospitalizations and Access to Health Care," Journal of the American Medical Association 274, no. 4 (1995): 305-311; and J. Hadley, E.P. Steinberg, and J. Feder, "Comparison of Uninsured and Privately Insured Hospital Patients: Condition on Admission, Resource Use, and Outcome," Journal of the American Medical Association 265, no. 3 (1991): 374-79.
32. A.B. Bindman et al., "Preventable Hospitalizations and Access to Health Care," Journal of the American Medical Association 274, no. 4 (1995): 305-311; and J. Hadley, E.P. Steinberg, and J. Feder, "Comparison of Uninsured and Privately Insured Hospital Patients: Condition on Admission, Resource Use, and Outcome," Journal of the American Medical Association 265, no. 3 (1991): 374-79.