A Comparison Study of Access to Health Care under a Medicaid Managed Care Program

Abstract

This article investigates the health care and insurance status of a low-income urban area in East Tennessee. The article reviews the background of TennCare, a compulsory Medicaid managed care program initiated in Tennessee in 1994. The study compared TennCare recipients with other insurance groups on key demographic and access variables. Possible explanations for how TennCare recipients rate their care also were examined. Qualitative analysis revealed accounts of long waiting periods, out-of-town specialist care, problems with obtaining pharmaceuticals, and general confusion about the new system. Implications of these findings for social work policy practitioners are discussed, and suggestions for alleviating the burden on patients are offered.

“The Rock Always Comes First”: Drug Users' Accounts About Using Formal Health Care

“…Even when drug users know about a particular service, structural elements such as the anticipated cost, lack of health insurance, lack of transpor tation, and difficulty accessing child care create barriers to getting health care (Ahmed et at. 2001;Rocha & Kabalka 1999).…”

Access to and Patterns of Use of Behavioral Health Services Among Children and Adolescents in TennCare

“…Several studies have examined TennCare's plan performance-for example, how individuals rate the performance on dimensions such as waiting time and ability to see a specialist-by using enrollee surveys (16)(17)(18)(19). These studies generally showed that TennCare's performance was no worse than that of the preexisting Medicaid program (17) and, although not as good as having private insurance (18), was better than having no insurance (20).…”

Heterogeneous Impact of Geographic Barriers on Provider Choice Evidence from New York County’s Health Market

“…What literature there is on the relationship between distance and choice of which provider to go to in a sizable urban environment is largely concerned with the use of providers of specific types of services-some of which may not be available in a hospital-rather than of hospitals themselves. Furthermore, with the notable exception of Luo and Wang's (2003) and Yang et al's (2006) articles that focus on Chicago, studies have often concentrated on cities that are either substantially smaller than New York, Los Angeles, Chicago, and San Francisco, such as Savannah, Georgia, and cities in Tennessee (Gesler & Meade, 1988;Rocha & Kabalka, 1999), or have investigated the question using cities that are physically as big as New York, Los Angeles, Chicago, and San Francisco but that have a notably lower population density, such as Atlanta (Peipins et al, 2011). Keating et al (2016) is an exception, but their study concerns female senior citizens-results for other segments of the population, particularly those of working age, may be quite different.…”