Effects of Medicaid Managed Care Programs on Health Services Access and Use

Garrett, Bowen; Davidoff, Amy J.; Yemane, Alshadye

doi:10.1111/1475-6773.00134

Cited by 50 publications

(54 citation statements)

References 12 publications

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“…Studies of the effect of MMC on women's health were also mixed. Women's participation in Medicaid HMO programs reduced non-ER use and increased reported unmet need for medical care (Garrett, Davidoff, and Yemane 2003), but had no effect on prenatal care use, birth outcomes, and cesarean section rates (Kaestner, Dubay, and Kenney 2002).…”

Section: Effect Of MMC On Overall Health Care Access and Utilizationmentioning

confidence: 99%

Effect of Medicaid Managed Care on Racial Disparities in Health Care Access

Cook

2007

Health Services Research

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Objective. To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Data Sources. Study Design. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. Principal Findings. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. Conclusions. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups represent the flexibility of MMC plans to locate primary care in ERs or an inefficient delivery of care.

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Section: Effect Of MMC On Overall Health Care Access and Utilizationmentioning

confidence: 99%

Effect of Medicaid Managed Care on Racial Disparities in Health Care Access

Cook

2007

Health Services Research

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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%

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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“…However, research has shown that PCCM increased the chances of a beneficiary seeing a physician relative to traditional Medicaid in the late 1980s (Hurley, Freund, and Paul 1993). More recent evidence on PCCMs in the context of a health care market that is more dominated by other forms of managed care suggest that Medicaid PCCMs have little effect on the likelihood that a beneficiary sees a physician (Garrett, Davidoff, and Yemane 2001).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…When this is the case, beneficiaries are required to select one of the two programs when they enroll. For those who do not choose, it is most common for them to be assigned to a PCCM provider (Garrett, Davidoff, and Yemane 2001). However, in some states, beneficiaries are assigned to PCCM or an HMO either randomly or based on place of residence.…”

Section: Conceptual Frameworkmentioning

confidence: 99%