Has Medicaid Managed Care Affected Beneficiary Access and Use?

Zuckerman, Stephen; Brennan, Niall; Yemane, Alshadye

doi:10.5034/inquiryjrnl_39.3.221

Cited by 45 publications

(45 citation statements)

References 15 publications

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“…As such, we developed a proxy measure for managed care enrollment, admittedly a less than ideal measure of actual managed care enrollment information. Building on previous research (Garrett, Davidoff, and Yemane 2003;Zuckerman, Brennan, and Yemane 2002), we based our proxy measure of managed care status on whether the individual lived in a county with a MMC program.…”

Section: Data Sourcesmentioning

confidence: 99%

“…National estimates of the impacts of MMC on other segments of the Medicaid population have been published (Currie and Fahr 2002;Kaestner, Dubay, and Kenney 2002;Garrett, Davidoff, and Yemane 2003;Zuckerman, Brennan, and Yemane 2002). To our knowledge, however, no comparable study has examined the effects of managed care on Medicaid beneficiaries with disabilities.…”

mentioning

confidence: 99%

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Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

Coughlin¹,

Long²,

Graves³

2008

INQUIRY

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States increasingly are shifting Medicaid beneficiaries with disabilities from the fee-for-service (FFS) delivery system to managed care in an effort to control program costs and address long-standing problems with access to care under the program. Using a county-based measure of managed care enrollment and pooled data from the 1997 to 2004 National Health Interview Surveys, we investigate whether Medicaid managed care (MMC), relative to FFS Medicaid, improves access to care. We find some evidence of improved access to care under MMC; however, the gains appear to be largely limited to beneficiaries in urban areas with fully capitated managed care. There is little evidence of improved access under primary care case management or, regardless of MMC type, in rural areas.

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Section: Data Sourcesmentioning

confidence: 99%

mentioning

confidence: 99%

Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

Coughlin¹,

Long²,

Graves³

2008

INQUIRY

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“…12 The advent of Medicaid managed care restructured the way in which health services were organized and financed for many poor women. [13][14][15] Other initiatives that were more variable from state-to-state and locality-to-locality were efforts to increase the number of health care providers in low-income areas, 16 expansions in the availability of neonatal intensive care, 17 and efforts to promote regular perinatal risk assessment and referral. 18 Generally, studies of disparities in maternal and infant health have focused on individual characteristics, such as a mother's race/ethnicity, income, or education.…”

Section: Methodsmentioning

confidence: 99%

Trends in Maternal and Infant Health in Poor Urban Neighborhoods: Good News from the 1990s, but Challenges Remain

2005

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Objectives. During the 1990s, numerous public policy changes occurred that may have affected the health of mothers and infants in low-income neighborhoods. This article examines trends in key maternal and child health indicators to determine whether disparities between high-poverty neighborhoods and other neighborhoods have declined. Methods. Using neighborhood-level vital statistics and U.S. Census data, we categorized “neighborhoods” (Census tracts) as being high poverty (greater than 30% of population below the federal poverty level in 1990) or not. We compared trends in four key indicators—births to teenagers, late prenatal care, low birthweight; and infant mortality—over the 1990s among high-poverty and other neighborhoods in Cuyahoga County, Ohio; Denver, Colorado; Marion County, Indiana; and Oakland, California. Results. In all four metropolitan areas, trends in high-poverty neighborhoods were more favorable than in other neighborhoods. The most consistently positive trend was the reduction in the rate of teen births. The metropolitan areas with the most intensive programs to improve maternal and child health—Cuyahoga County and Oakland—saw the most consistent improvement across all indicators. Still, great disparities between high-poverty and other neighborhoods remain, and only Oakland shows promise of achieving some of the Healthy People 2010 maternal and child health goals in its high-poverty neighborhoods. Conclusions. While there has been a reduction in maternal and infant health disparities between high-poverty and other neighborhoods, much work remains to eliminate disparities and achieve the 2010 goals. Small area data are useful in isolating the neighborhoods that should be targeted. Experience from the 1990s suggests that a combination of several intensive interventions can be effective at reducing disparities.

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“…Children in Medicaid health maintenance organizations (HMOs) have fewer ED visits and more well-child visits than other Medicaid-insured children. 19 Fewer children are hospitalized for preventable reasons in counties with greater HMO penetration. 20 n Policy implications.…”

Section: Voltage Drop 3: Access To Covered Services and Providersmentioning

confidence: 99%

Access And Quality In Child Health Services: Voltage Drops

Schuster

2004

Health Affairs

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Children require a health care system that promotes healthy development for all children while reaching out to the neediest. Barriers to care have been described as "voltage drops"-resistance points at which patients drop from the system like voltage from an electrical current. We examine the size and nature of these drops, ranging from insurance access to service quality, with respect to children. We find critical policy needs (such as expanded insurance opportunities, increased care coordination, and improved quality measurement) at all system levels. Comprehensive access to insurance and services does not guarantee that children will receive high-quality (safe and effective) care. C h i l d h o o d i s a u n i q u e p e r i o d of rapid growth and development char-acterized by dependency, vulnerability, and, for a disproportionate number of children, poverty. The U.S. health care system, best suited to acute care for adults, struggles to accommodate vulnerable populations (such as the elderly or mentally ill). Children require a protective, preventive system-one that helps families anticipate upcoming needs, monitors problems as they arise, and coordinates services. Developing such a system is a critical health policy frontier.It is essential to understand where the current system succeeds and fails for children. John Eisenberg and Elaine Power adopted the term "voltage drops." Just as an electrical system loses voltage when current passes through resistance, the health care system loses people as they confront barriers in seven areas: access to insurance coverage, enrollment in available insurance plans, access to covered services/providers, choice of plans/providers, consistent access to primary care, access to referral services, and delivery of high-quality care. 1 For children, evidence is scant regarding one drop, the impact of plan/provider choice. The other six drops, however, clearly have policy implications that are the focus of this paper. How large are these drops for children, and how might they be reduced?

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Has Medicaid Managed Care Affected Beneficiary Access and Use?

Cited by 45 publications

References 15 publications

Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

Trends in Maternal and Infant Health in Poor Urban Neighborhoods: Good News from the 1990s, but Challenges Remain

Access And Quality In Child Health Services: Voltage Drops

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