Does medicaid managed care affect access to care for the uninsured?

Health Affairs

Volumn 24, Issue 4, 2005, Pages 1095-1105

  Haberer, Jessica E ^a   Garrett, Bowen ^b   Baker, Laurence C ^c  

^a CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION   (China)

^b URBAN INSTITUTE   (United States)

^c STANFORD UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ADULT; ARTICLE; CHILD; COMPARATIVE STUDY; EPIDEMIOLOGY; EVALUATION; FEMALE; HEALTH CARE DELIVERY; HEALTH INSURANCE; HUMAN; MALE; MEDICAID; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; PATIENT; POVERTY; SOCIOECONOMICS; STATISTICAL MODEL; STATISTICS; UNITED STATES;

ADOLESCENT; ADULT; CHILD; FEMALE; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; LOGISTIC MODELS; MALE; MANAGED CARE PROGRAMS; MEDICAID; MEDICALLY UNINSURED; MIDDLE AGED; POVERTY; SAMPLING STUDIES; SOCIOECONOMIC FACTORS; UNITED STATES;

EID: 23044472389     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.24.4.1095     Document Type: Article

References (39)

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2. and R. Hurley, D. Freund, and J. Paul, Managed Care in Medicaid: Lessons for Policy and Program Design (Ann Arbor, Mich.: Health Administration Press, 1993), 1-7.
3. P.J. Cunningham, "Pressures on Safety Net Access: The Level of Managed Care Penetration and Uninsurance Rate in a Community," Health Services Research 34, no. 1, part 2 (1999): 255-270.
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7. R.E. Hurley and S.A. Somers, "Medicaid and Managed Care: A Lasting Relationship?" Health Affairs 22, no. 1 (2003): 77-88;
8. and H. Waitzkin et al., "Safety-Net Institutions Buffer the Impact of Medicaid Managed Care: A Multi-Method Assessment in a Rural State," American Journal of Public Health 92, no. 4 (2002): 598-610.
9. See Norton and Lipson, "Public Policy";
10. and J. Holahan et al., "Medicaid Managed Care in Thirteen States," Health Affairs 17, no. 3 (1998): 43-63.
11. L. Shi et al., "Managed Care and Community Health Centers," Journal of Ambulatory Care Management 23, no. 1 (2000): 1-22;
12. J.S. McAlearney, "The Financial Performance of Community Health Centers, 1996-1999," Health Affairs 21, no. 2 (2002): 219-225;
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14. T.A. Coughlin et al., "A Conflict of Strategies: Medicaid Managed Care and Medicaid Maximization," Health Services Research 34, no. 1, part 2 (1999): 281-293;
15. and M.K. Gusmano et al., "The Evolving Role and Care Management Approaches of Safety-Net Medicaid Managed Care Plans," Journal of Urban Health 79, no. 4 (2002): 600-616.
16. Two national studies report that in states with higher MMC enrollments, uninsured people are less likely than low-income insured people to report having a usual source of care or a usual physician. See Cunningham, "Pressures on Safety Net Access";
17. and P.J. Cunningham and S. Trude, "Does Managed Care Enable More Low Income Persons to Identify a Usual Source of Care? Implications for Access to Care," Medical Care 39, no. 7 (2001): 716-726.
18. Two other analyses of single-state programs show mixed results. See Waitzkin et al., "Safety-Net Institutions";
19. and L. Moreno and S.D. Hoag, "Covering the Uninsured through TennCare: Does It Make a Difference?" Health Affairs 20, no. 1 (2001): 231-239.
20. Centers for Medicare and Medicaid Services, "Enrollment Statistics," 16 September 2004, www.cms.hhs.gov/medicaid/managedcare/ enrolstats.asp (26 April 2005).
21. Centers for Disease Control and Prevention, National Center for Health Statistics, "National Health Interview Survey," 19 April 2005, www.cdc.gov/nchs/nhis.htm (26 April 2005).
22. NCHS, 1997 National Health Interview Survey (NHIS) Public Use Data Release: NHIS Survey Description (Hyattsville, Md: NCHS, 2000), 4-5.
23. A. Yemane, "2001 Medicaid Managed Care County Implementation Survey Description" (Washington: Urban Institute, 2003).
24. See Cunningham, "Pressures on Safety Net Access";
25. and Cunningham and Trude, "Does Managed Care Enable More Low Income Persons to Identify?"
26. The NHIS is conducted annually and samples within selected primary sampling units. Thus, the NHIS data do not include all U.S. counties every year, and sampled counties vary from year to year. In our data, 827-974 counties are represented in the data, depending on the subgroup. Some of these counties appear in one year of data; others appear in multiple years. Of those that appear in multiple years, 186-326 counties changed MMC status over time, depending on the sample.
27. M.B. McClellan and D. Staiger, "Comparing the Quality of Heahh Care Providers," in Frontiers in Health Policy Research, ed. A.M. Garber (Cambridge, Mass.: MIT Press, 2000), 113-136.
28. J.M. Wooldridge, Econometric Analysis of Cross Section and Panel Data (Cambridge, Mass.: MIT Press, 2002), 454-457.
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30. SAS Version 8 (Cary, N.C.: SAS Institute, 1999);
31. and SUDAAN Release 8.0 (Research Triangle Park, N.C.: RTI, 2001).
32. We found that the prevalence of a usual source of care ranged from 53.1 percent to 61.1 percent in counties that always had MMC, 57.0 percent to 68.5 percent in counties that implemented MMC, and 56.8 percent to 73.9 percent in counties that never had MMC.
33. See Cunningham, "Pressures on Safety Net Access"; and
34. Cunningham and Trude, "Does Managed Care Enable More Low Income Persons to Identify?";
35. and Moreno and Hoag, "Covering the Uninsured."
36. M. Gold et al., "Participation of Plans and Providers in Medicaid and SCHIP Managed Care," Health Affairs 22, no. 1 (2003): 230-240.
37. See Coughlin et al, "A Conflict of Strategies";
38. and Gusmano et al., "The Evolving Role."
39. M. Duggan, "Does Contracting Out Increase the Efficiency of Government Programs? Evidence from Medicaid HMOs," NBER Working Paper no. 9091 (Cambridge, Mass.: National Bureau of Economic Research, 2002).