Health Centers and the Healthcare System

Zuvekas, Ann

doi:10.1097/00004479-200510000-00008

Cited by 9 publications

(3 citation statements)

References 8 publications

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“…By reducing the SNIs' ability to cross-subsidize care, the onset of MMC raised fears that access barriers for the uninsured would become even more problematic than in the past (Institute of Medicine, 2000). Indeed, although some SNIs endured and even flourished under MMC, others encountered major crises (Bindman, Yoon, & Grumbach, 2003;Felland et al, 2003;Jacobson, Dalton, Berson-Grand, & Weisman, 2005;Sparer, Brown, Gusmano, Rowe, & Gray, 2002;Waitzkin et al, 2008;Zuvekas, 2005).…”

Section: The Incentive Structure Of MMCmentioning

confidence: 99%

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

2008

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Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on "disciplined" providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.

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Section: The Incentive Structure Of MMCmentioning

confidence: 99%

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

2008

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“…Regarding our concern about research questions at the organizational/ community level, while some safety net institutions survived and even flourished under MMC, others encountered major crises (Sparer et al 2002;Bindman, Yoon, and Grumbach 2003;Felland et al 2003;Jacobson et al 2005;Zuvekas 2005). Some but not all states included rural areas in MMC (Slifkin et al 1998).…”

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

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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

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“…By understanding the needs of health care providers, strategies may be implemented to enhance their satisfaction and guarantee continued support for the program [10,15]. The continued participation of health care providers can also be enhanced by targeting issues that are identified to affect their satisfaction directly in participating with community-based health programs [4,16].…”

Section: Introductionmentioning

confidence: 99%

Factors for Satisfaction Among Providers of Ancillary Health Services in a Community-Based Cancer Prevention Program: A Pilot Study in Nevada

Gorospe

Cochran²,

Cabb³

2006

The Scientific World JOURNAL

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Providers of ancillary health services are essential members of any health care delivery system. They supply laboratory, radiology, and other diagnostic modalities necessary for quality medical care. Assessment of the providers' factors for satisfaction in participating in cancer prevention programs can contribute to better services and can serve as a model for other community-based health programs.We conducted a pilot survey of providers of ancillary services in the Nevada Women's Health Connection, a community breast and cervical cancer prevention program. Of the 93 participating providers, a total of 44 providers completed the survey. We subjected the survey data to factor analysis using iterative principal axis factoring with Varimax rotation. Three components of satisfaction were identified, comprising satisfaction with the (1) reimbursement process, (2) positive perception of the program, and (3) familiarity with program's requirements. All three components accounted for 72.08% of the total variance before the rotation. Amount of financial gain was not a significant factor for satisfaction among participating providers. Providers of ancillary health services were satisfied in their participation in this community-based cancer prevention program. There were three components of satisfaction identified. Further attention should be given on these issues as they have implications for quality improvement in health services for community-based programs dealing with low income and uninsured patients.

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Health Centers and the Healthcare System

Cited by 9 publications

References 8 publications

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

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

Factors for Satisfaction Among Providers of Ancillary Health Services in a Community-Based Cancer Prevention Program: A Pilot Study in Nevada

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