Does Medicaid Managed Care Affect Access To Care For The Uninsured?

Haberer, Jessica; Garrett, Bowen; Baker, Laurence C.

doi:10.1377/hlthaff.24.4.1095

Cited by 3 publications

(3 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding our interest in questions about individuallevel impacts, some MMC programs led to improved or unchanged access for Medicaid recipients, while other programs manifested enduring access barriers (Baker and Afendulis 2005;Berman, Armon, and Todd 2005;Fairbrother et al 2005;Sommers 2005;Seligman et al 2007); MMC exerted no consistent effects on access for the uninsured (Haberer, Garrett, and Baker 2005). Utilization under MMC proved inconsistent, even involving services targeted for reduction such as emergency department visits (Alessandrini et al 2001b;Garrett, Davidoff, and Yemane 2003;Davidoff et al 2007).…”

Section: Background On MMCmentioning

confidence: 99%

Multimethod Evaluation of Health Policy Change: An Application to Medicaid Managed Care in a Rural State

Waitzkin

Schillaci

Willging

2008

Health Services Research

View full text Add to dashboard Cite

Objective. To answer questions about the impacts of Medicaid managed care (MMC) at the individual, organizational/community, and population levels of analysis. Data Sources/Study Setting. Multimethod approach to study MMC in New Mexico, a rural state with challenging access barriers. Study Design. Individual level: surveys to assess barriers to care, access, utilization, and satisfaction. Organizational/community level: ethnography to determine changes experienced by safety net institutions and local communities. Population level: analysis of secondary databases to examine trends in preventable adverse sentinel events. Data Collection/Extraction Methods. Survey: multivariate statistical methods, including factor analysis and logistic regression. Ethnography: iterative coding and triangulation to assess documents, field observations, and in-depth interviews. Secondary databases: plots of sentinel events over time. Principal Findings. The survey component revealed no consistent changes after MMC, relatively favorable experiences for Medicaid patients, and persisting access barriers for the uninsured. In the ethnographic component, safety net institutions experienced increased workload and financial stress; mental health services declined sharply. Immunization rate, as an important sentinel event, deteriorated. Conclusions. MMC exerted greater effects on safety net providers than on individuals and did not address problems of the uninsured. A multimethod approach can facilitate evaluation of change in health policy.Key Words. Medicaid managed care, safety net, multimethod research, access, ethnographyIn health services research, the problem of how to evaluate the results of policy change has remained challenging (Evaluation Gap Working Group 2006

show abstract

Section: Background On MMCmentioning

confidence: 99%

Multimethod Evaluation of Health Policy Change: An Application to Medicaid Managed Care in a Rural State

Waitzkin

Schillaci

Willging

2008

Health Services Research

View full text Add to dashboard Cite

show abstract

“…(Cunningham 1999;Waitzkin et al, 2002) In a notable exception, however, it was reported in one study that, "safety-net providers are coping". (Haberer et al, 2005) Since the mid-2000s, there has been a relative lull in the literature concerning the effects of Medicaid managed care on safety-net hospitals, with a complete absence in the field of economics. This study revisits the issue for two reasons.…”

Section: Medicaid Managed Care and The Safety-netmentioning

confidence: 99%

A Leak in the Lifeboat: The effect of Medicaid managed care on the vitality of safety-net hospitals

Woodworth

2016

J Regul Econ

View full text Add to dashboard Cite

States are increasingly adopting Medicaid managed care in efforts to address budgetary concerns. The intent is that by releasing Medicaid oversight to private organizations, competition will drive down healthcare expenditures so that savings may be passed to the state. Yet there are concerns that this competitive solution to cost savings might compromise safety-net hospitals. Managed care organizations cut costs by restricting the providers that enrollees are allowed to see. If movement in Medicaid patients disrupts safety-net hospitals' casemix, this could affect their ability to cross-subsidize care. This study estimates the impact of Medicaid managed care on safety-net hospitals by exploiting a Florida pilot program that required Medicaid recipients in five counties to enroll in managed care. The results suggest this mandate led to a small reduction in safety-net hospitals' average ratio of payment-to-cost. There is also some evidence that the effect on safetynet hospitals was disproportionate. This disproportionality was such that hospitals nearest the margin were pushed the furthest towards the edge.

show abstract

“…Researchers also could benefit from better data on Medicaid managed care penetration (at the local level) as well as from information on capitation rates. There are some papers on the impact of Medicaid managed care (e.g., Aizer, Currie, and Moretti 2007;Haberer, Garrett, and Baker 2005;Long and Yemane 2005;Currie and Fahr 2004;Garrett, Davidoff, and Yemane 2003), but more questions could be answered with additional data. % Policy parameters.…”

Section: Current Database Effortsmentioning

confidence: 99%

Data Needs for Policy Research on State-Level Health Insurance Markets

Simon¹

2008

INQUIRY

View full text Add to dashboard Cite

Private and public health insurance provision in the United States operates against a backdrop of 50 different regulatory environments in addition to federal rules. Through creative use of available data, a large body of research has contributed to our understanding of public policy in state health insurance markets. This research plays an important role as recent trends suggest states are taking the lead in health care reform. However, several important questions have not been answered due to lack of data. This paper identifies some of these areas, and discusses how the Agency for Healthcare Research and Quality could push the research agenda in state health insurance policy further by augmenting the market-level data available to researchers. As states consider new forms of regulation and assistance for their insurance markets, there is increased need for better warehousing and maintenance of policy databases.Americans face a patchwork of different markets providing health insurance. These markets, be they private or public, are governed by several sets of regulations enacted at the state as well as federal level. The variation that exists in policies, particularly at the state level, has spawned a large literature assessing the policies' impacts on health insurance and related outcomes. Yet several new questions could be answered if additional market-level data were collected. The Agency for Healthcare Research and Quality (AHRQ) has an opportunity to further the research by facilitating the creation of such resources. In this paper, I briefly review the available market-level data, 1 research questions that have been explored with these measures, and identify additional questions that could be answered with new data. This paper begins with a review of the different segments of markets for health insurance. Regulating Private vs. Public Health InsuranceThe private insurance market consists of two separate domains-group and nongroup markets-which are further split in the manner shown in Figure 1. To convey a sense of the relative sizes of some of these components, in 2004 about 161.5 million individuals (or 63.3% of all nonelderly Americans) held employer health insurance, while 11.2% of the nonelderly held coverage through Medicaid/State Children's Health Insurance Program (SCHIP), 2.3% held Medicare/Tricare coverage, 5.4% had directly

show abstract

Does Medicaid Managed Care Affect Access To Care For The Uninsured?

Cited by 3 publications

References 14 publications

Multimethod Evaluation of Health Policy Change: An Application to Medicaid Managed Care in a Rural State

Multimethod Evaluation of Health Policy Change: An Application to Medicaid Managed Care in a Rural State

A Leak in the Lifeboat: The effect of Medicaid managed care on the vitality of safety-net hospitals

Data Needs for Policy Research on State-Level Health Insurance Markets

Contact Info

Product

Resources

About