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Keywords:

  • Medicaid managed care;
  • access to care;
  • insurance expansion

Objective. To evaluate the effects of the Oregon Health Plan (OHP) on beneficiary access and satisfaction.

Data Sources. Telephone survey of nondisabled adults in 1998.

Study Design. Two groups of adults were surveyed: OHP enrollees and Food Stamp recipients not enrolled in OHP. The Food Stamp sample included both privately insured and uninsured recipients. This allowed us to disentangle the insurance effects of OHP from other effects such as its reliance on managed care and the priority list. OHP and Food Stamp adults were compared along the following measures: usual source of care, utilization of health care services, unmet need, and satisfaction with care.

Data Collection. The survey was conducted by telephone, using computer-assisted telephone interviewing techniques.

Principal Findings. Much of OHP's impact has been realized by its extension of health insurance coverage to Oregon's low-income residents. The availability of health insurance significantly increased the utilization of many health care services and reduced unmet need for care. OHP was associated within a higher percentage of enrollees having a usual source of care and higher rates of Pap test screening among women compared with Food Stamp recipients. OHP enrollees also reported significantly higher use of dental care and prescription drugs; use we attribute to the expanded benefit package under the priority list. At the same time, OHP enrollees reported a greater unmet need for prescription drugs. Drug treatment for below-the-line conditions was one reason for this unmet need, but often the specific drug simply was not in the plan's formulary. OHP enrollees were as satisfied with their health care as those Food Stamp recipients with private health insurance.

Conclusions. Despite the negative publicity prior to its implementation, there is no evidence that “rationing” under OHP's priority list has substantially restricted access to needed services. OHP adults appear to enjoy access equal to or better than that of low-income persons with private health insurance and have far greater access than the uninsured.