Translating research to action: Improving physician access in public insurance

Journal of Ambulatory Care Management

Volumn 29, Issue 1, 2006, Pages 36-50

  Gold, Marsha ^a   Kuo, Sylvia ^b   Taylor, Erin Fries ^a  

^a MATHEMATICA POLICY RESEARCH   (United States)

^b BROWN UNIVERSITY   (United States)

Author keywords

Access to care; Informed policymaking; Physician access; Public insurance

Indexed keywords

HEALTH CARE ACCESS; HEALTH CARE AVAILABILITY; HEALTH CARE POLICY; HEALTH INSURANCE; MEDICAID; MEDICAL RESEARCH; PHYSICIAN; REVIEW; ARTICLE; HEALTH CARE DELIVERY; HUMAN; MANAGEMENT; ORGANIZATION AND MANAGEMENT; RESEARCH; UNITED STATES;

HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE, HEALTH; POLICY MAKING; PUBLIC SECTOR; RESEARCH; UNITED STATES;

EID: 33644874610     PISSN: 01489917     EISSN: None     Source Type: Journal    
DOI: 10.1097/00004479-200601000-00005     Document Type: Review

References (83)

1. Aday, L., & Andersen, R. M. (1981). Equity in access to medical care: Realized and potential. Medical Care, 19(12, Suppl.), 4-27.
2. Aizer, A., Gold, M., & Schoen, C. (1998). Managed care and low-income populations: Four years' experience with TennCare. Washington, DC: Mathematica Policy Research.
3. Andersen, R. M. (1968). Behavioral model of families: Use of health services (Research Series No. 25). Chicago: University of Chicago, Center for Health Administration Studies.
4. Berman, S., Dolins, J., Tans, S.-F., & Yudkowsky, B. (2002). Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients. Pediatrics, 110(2), 239-248.
5. Bindman, A., Chattopadhyay, A., Osmond, D., Huen, W., & Bacchetti, P. (2004). Preventing unnecessary hospitalizations in Medi-Cal: Comparing fee-for-service with managed care. Oakland: California HealthCare Foundation.
6. Bindman, A., Yoon, J., & Grumbach, K. (2003). Trends in physician participation in Medicaid: The California experience. Journal of Ambulatory Care Management, 26(4), 334-343.
7. Bindman, A., Huen, W., Vranizan, K., Yoon, J., Grumbach, K., & Streett, L. (2002). Physician participation in Medi-Cal, 1996-1998. Oakland, CA: Medi-Cal Policy Institute.
8. Brasure, M., Stearns, S. C., Norton, E. C., & Ricketts, T., III. (1999). Competitive behavior in local physician markets. Medical Care Research and Review, 56(4), 395-414.
9. Bronstein, J. M., Adams, K., & Florence, C. S. (2004). The impact of SCHIP enrollment on physician participation in Medicaid in Alabama and Georgia. Health Services Research, 39(2), 301-317.
10. Brown, R., Wooldridge, J., Hoag, S., & Moreno, L. (2001). Reforming Medicaid: The experiences of five pioneering states with mandatory managed care and eligibility expansions. Washington, DC: Mathematica Policy Research.
11. Brown, E. R., Lavarreda, S. A. Meng, Y.-Y. Andersen, R. M., Bindman, A. B., Belberg, L., et al. (2003). Measuring access to physician services in Medi-Cal and Healthy Families. UCLA Center for Health Policy Research.
12. California HealthCare Foundation. (2004). Access to physician services in California's public insurance programs. Oakland: Author.
13. Center for Health Policy Research. (1997). Physician marketplace statistics, 1996. Chicago: American Medical Association.
14. Center for Health Services Research and Policy. (2001). Medicaid managed care database and State Children's Health Insurance Program database. Negotiating the new health system (4th ed.). Washington, DC: George Washington Center for Health Services Research and Policy.
15. Coburn, A. F., Long, S. H., & Marquis, M. S. (1999). Effects of changing Medicaid fees on physician participation and enrollee access. Inquiry, 36, 265-279.
16. Cohen, J. W. (1993). Medicaid physician fees and use of physician and hospital services. Inquiry, 30, 281-292.
17. Cohen, J. W., & Cunningham, P. J. (1995). Medicaid physician fee levels and children's access to care. Health Affairs, 14(1), 255-262.
18. Collins, K. S., Hughes, D. L., Doty, M. M., Ives, B. L., Edwards, J. N., & Tenney, K. (2002). Diverse communities, common concerns: Assessing health care quality for minority Americans (The Commonwealth Fund Report #523). New York: The Commonwealth Fund.
19. Cooper, L. A., Roter, D. L., Johnson, R. L., Ford, D. E., Steinwachs, D. M., & Powe, N. R. (2003). Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine, 139(11), 907-916.
20. Coye, M., & Alvarez, D. (1999). Medicaid managed care and cultural diversity in California (The Commonwealth Fund Report). New York: The Commonwealth Fund.
21. Davis, K., & Schoen, C. (1978). Health and the war on poverty: A ten-year appraisal. Washington, DC: Brookings Institution.
22. Draper, D., Hurley, R. E., & Short, A. C. (2004). Medicaid managed care: The last bastion of the HMO? Health Affairs, 23(2), 155-167.
23. Felt-Lisk, S. (1999). The changing Medicaid managed care market: Trends in commercial plans' participation (Issue Brief). Washington, DC: The Kaiser Commission on Medicaid and the Uninsured.
24. Felt-Lisk, S. (2000). Monitoring quality in Medicaid managed care: Accomplishments and challenges at the year 2000. Journal of Urban Health, 77(4), 536-559.
25. Felt-Lisk, S., Mittler, J., & Cassidy, A. (2001). Ensuring special needs populations' access to providers in managed care networks: A technical assistance and self-assessment tool for state Medicaid agencies (Center for Health Care Strategies (CHCS) Informed Purchasing Series Paper). Lawrenceville, NJ: CHCS.
26. Fossett, J. W., & Perloff, J. D. (1999). The "new" health reform and access to care: The problem of the inner city. In M. Lillie-Blanton, R. Marie Martinez, B. Lyons, & D. Rowland (Eds.), Access to health care: Promises and prospects for low-income Americans (pp. 97-121). Washington, DC: The Kaiser Commission on Medicaid and the Uninsured.
27. Fossett, J. W., Peterson, J. A., & Ring, M. C. (1989). Public sector primary care and Medicaid: Trading accessibility for mainstreaming. Journal of Health Politics, Policy and Law, 14(2), 309-325.
28. Fox, M. H., Moore, J., Zimmerman, M., Hill, S., & Foster, C. H. (2001). The effectiveness of CAHPS among women enrolling in Medicaid managed care. Journal of Ambulatory Care Management, 24(4), 76-91.
29. Gabel, J., Hunt, K., & Kim, J. (1998). The financial burden of self-paid health insurance on the poor and near-poor. New York: The Commonwealth Fund.
30. Gifford, B. (1997). Obstetricians' receptiveness to teen prenatal patients who are Medicaid recipients. Health Services Research, 32(3), 265-282.
31. Gold, M. (1998). Beyond coverage and supply: Measuring access to health care in today'smarket. Health Services Research, 33(2, Pt. II), 625-652.
32. Gold, M. (1999). Insight from Oregon and Tennessee: The role of state context on Medicaid health reform initiatives and low-income populations. In M. Lillie-Blanton, R. Marie Martinez, B. Lyons, & D. Rowland (Eds.), Access to health care: Promises and prospects for lowincome Americans (pp. 199-221). Washington, DC: The Kaiser Commission on Medicaid and the Uninsured.
33. Gold, M., & Mittler, J. (2000). Second generation Medicaid managed care: Can it deliver? Health Care Financing Review, 22(2), 29-47.
34. Gold, M., Mittler, J., Draper, D., & Rousseau, D. (2003). Participation of plans and providers in Medicaid and SCHIP managed care. Health Affairs, 22(1), 230-240.
35. Gold, M., Mittler, J., & Lyons, B. (2000). Oil and water? Lessons from Maryland's effort to protect safety net providers in moving to Medicaid managed care. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 77(4), 645-662.
36. Hadley, J. (2003). Sicker and poorer: The consequences of not covering the uninsured. Medical Care Research and Review, 60(2, Suppl.), 35S-755S.
37. Holahan, J., Coughlin, T. A., Bovbjerg, R. R., Hill, I., Ormond, B. A., & Zuckerman, S. (2004). State responses to 2004 budget crises: A look at ten states. Washington, DC: The Urban Institute.
38. Holahan, J., & Suzuki, S. (2003). Medicaid managed care payment methods and capitation rates in 2001. Health Affairs, 22(1), 204-218.
39. Holahan, J., Wiener, J. M., Lutzky, A. W. (2002). Health policy for low-income people: States' responses to new challenges. Health Affairs, W187-W218.
40. Holahan, J., Zuckerman, S., Evans, A., & Rangarajan, S. (1998). Medicaid managed care in thirteen states. Health Affairs, 17(3), 43-63.
41. Hudman, J., & O'Malley, M. (2003). Health insurance premiums and cost-sharing: Findings from the research on low-income populations (Kaiser Commission on Medicaid and the Uninsured Policy Brief). Washington, DC: Kaiser Family Foundation.
42. Hurley, R., & Zuckerman, S. (2002). Medicaid managed care: State flexibility in action. Urban Institute Discussion Paper No. 02-06. Washington, DC: The Urban Institute.
43. Institute of Medicine. (1993). A model for monitoring access. In M. Millman (Ed.), Access to health care in America (pp. 31-45). Washington, DC: National Academy Press.
44. Institute of Medicine. (1996). The nation's physician workforce: Options for balancing supply and requirements. Washington, DC: National Academy Press.
45. Institute of Medicine. (2001). Coverage matters: Insurance and health care. Washington, DC: National Academy of Sciences.
46. Institute of Medicine. (2003). Assessing potential sources of racial and ethnic disparities in care: Patient- and system-level factors. In B. D. Smedley, A. Y. Stith, & A. R. Nelson (Eds.), Unequal treatment: Confronting racial and ethnic disparities in health care (pp. 125-159). Washington, DC: National Academy Press.
47. Kaiser Commission of Medicaid and the Uninsured. (2004). State fiscal conditions and Medicaid. Kaiser Commission of Medicaid and the Uninsured Medicaid Facts. Washington, DC: Kaiser Family Foundation.
48. Kaplan, S. A., Greene, J., Molnar, C., Bernstein, A., & Ghanbarpour, S. (2000). Educating Medicaid beneficiaries about managed care: Approaches in 13 cities (The Commonwealth Fund Report #380). New York: The Commonwealth Fund.
49. Kaye, N. (2004). Medicaid managed care: A guide for states (5th ed.). Retrieved June 24, 2002, from http://www.nashp.org
50. Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., et al. (1996). The role of Black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine, 334(20), 1305-1310.
51. Konrad, T. R., Leysieffer, K., Stevens, C., Irvin, C., Martinez, R. M., & Nguyen T. T. H. (2000). Evaluation of the effectiveness of the National Health Service Corps (Final Report). Cambridge, MA: Mathematica Policy Research.
52. Lake Snell Perry and Associates. (2001). Medi-Cal and Healthy Families: Focus groups with California parents to evaluate the Medi-Cal and Healthy Families programs. Menlo Park, CA: The Kaiser Family Foundation.
53. LaVeist, T. A., Bowie, J. V., & Cooley-Quille, M. (2000). Minority health status in adulthood: The middle years of life. Health Care Financing Review, 21(4), 9-21.
54. Leichter, H. M. (1999). The poor and managed care in Oregon experience. Journal of Health Politics, Policy and Law, 24(5), 1173-1184.
55. Lillie-Blanton, M. (1999). A reviewof the nation's progress and challenges in assuring access to health care for low-income Americans. In M. Lillie-Blanton, R. M. Martinez, B. Lyons, & D. Rowland (Eds.), Access to health care: Promises and prospects for low-income Americans (pp. 19-37). Washington, DC: The Kaiser Commission on Medicaid and the Uninsured.
56. Maloy, K. A., Rosenbaum, S., Darnell, J., Silver, K., Kreling, B., & Kenney, K. A. (1999). Results of a multi-site study of mandatory Medicaid managed care-enrollment systems: Implications for policy and practice. In Center for Health Services Research Policy Report (pp. i-vii). Washington, DC: George Washington University Medical Center.
57. Medicaid Access Study Group. (1994). Access of Medicaid Recipients to Outpatient Care. The New England Journal of Medicine, 330(20), 1426-1430.
58. Mitchell, J. B. (1991). Physician participation in Medicaid revisited. Medical Care, 29(7), 645-653.
59. Mofidi, M., Rozier, G. R., & King, R. S. (2002). Problems with access to dental care for Medicaid-insured children: What caregivers think. American Journal of Public Health, 92(1), 53-58.
60. National Conference of State Legislatures. (2001). The health care workforce in ten states: Education, practice and policy - WISCONSIN. Washington, DC: Department of Health and Human Services.
61. National Governors Association. (2003). Doing more with less: Recent state coverage expansions (NGA Center for Best Practices Issue Brief). Washington, DC: Author.
62. Newhouse, J. (2001). Free for all? Lessons from The Rand National Health Insurance Experiment. Cambridge, MA: Howard University Press.
63. Norton, S. (1999). Recent trends in Medicaid physician fees, 1993-1998. Urban Institute Discussion Paper 99-12. Washington, DC: The Urban Institute.
64. O'Brien, M. J., Archdeacon, M., Barrett, M., Crow, S., Janicki, S., Rousseau, D., & Williams, C. (2000). State experiences with cost-sharing mechanisms in children's health insurance expansions (The Commonwealth Fund Report #385). New York: The Commonwealth Fund.
65. Perloff, J. D., Kletke, P., & Fossett, J. W. (1995). Which physicians limit their medical participation and why. Health Services Research, 30(1, Pt. I), 7-26.
66. Perloff, J. D., Kletke, P., Fossett, J. W., & Banks, S. (1997). Medical participation among urban primary care physicians. Medical Care, 35(2), 142-157.
67. Pauthman, D. E., Konrad, T. R., King, T. S., Taylor, D. H., & Koch, G. G. (2004). Outcomes of state scholarship, loan repayment and related programs for physicians. Medical Care, 42(6), 560-568.
68. Rabinowitz, H. K., Diamond, J. J., Veloski, J. J., & Gayle, J. A. (2000). The impact of multiple predictors on generalist physicians' care of underserved populations. American Journal of Public Health, 90(8), 1225-1228.
69. Rice, T., & Gabel, J. (1996). The internal economics of HMOs: A research agenda. Medical Care Research and Review, 53(Suppl.), S48-S64.
70. Rosenbaum, S. (1998). Negotiating the new health system: A nationwide analysis of Medicaid managed care contracts. In M. D. Stephen & A. S. Stephen (Eds.), Remaking Medicaid: Managed care for the public good (pp. 197-218). San Francisco: Jossey-Bass.
71. Rosenbaum, S., Johnson, K., Sonosky, C., Markus, A., & DeGraw, C. (1998). The children's hour: The State Children's Health Insurance Program. Health Affairs, 17(1), 75-88.
72. Rosenbaum, S., Shaw, K., & Sonosky, C. (2001). Policy brief #3: Managed care purchasing under SCHIP: A nationwide analysis of freestanding SCHIP contracts. In SCHIP Policy Studies Project. Washington, DC: George Washington Center for Health Services Research and Policy.
73. Singer, J. D., Davidson, S. M., Graham, S., & Davidson, H. S. (1998). Physician retention in community and migrant health centers: Who stays and for how long? Medical Care, 36(8), 1198-1213.
74. Skaggs, D. L., Clemens, S. M., Vitale, M. G., Femino, J. D., & Kay, R. M. (2001). Access to orthopedic care for children with Medicaid versus private insurance in California. Pediatrics, 107(6), 1405-1408.
75. Sloan, F. A., Conover, C. J., & Rankin, P. J. (1999). Physician participation and nonparticipation in Medicaid managed care: The TennCare experience. Southern Medical Journal, 92(11), 1064-1070.
76. Stokoe, U. (1992). Physician recruitment and retention in community health centers. Journal of Ambulatory Care Management, 15(1), 21-28.
77. Strunk, B. P., & Cunningham, P. J. (2002). Treading water: Americans' access to needed medical care, 1997-2001 (Tracking Report No. 1). Washington, DC: Center for Studying Health System Change.
78. U.S. Department of Health and Human Services, Health Resources and Services Administration. (2001). The health care workforce in ten states: Education, practice and policy. Washington, DC: Author.
79. U.S. General Accounting Office. (1997). Health insurance: Coverage leads to increased health care access for children (GAO/HEHS-98-14). Washington, DC: Author.
80. U.S. General Accounting Office. (1999). Physician shortage areas: Medicare incentive payments not an effective approach to improve access (GAO/HEHS-99-36). Washington, DC: Author.
81. Wooldridge, J., Ku, L., Coughlin, T., Dubay, L., Ellwood, M., & Rajan, S., et al. (1997). Reforming state Medicaid programs: First-year implementation experiences from three states. Washington, DC: Mathematica Policy Research.
82. Yoon, J., Grumbach, K., & Bindman, A. (2004). Access to Spanish-speaking physician in California: Supply, insurance or both. Journal of the American Board of Family Practice, 17(3), 165-172.
83. Youdelman, M., & Perkins, J. (2002). Providing language interpretation services in health care settings: Examples from the field (Commonwealth Foundation Report #541). New York: The Commonwealth Foundation.