This paper was funded by the Kaiser Commission on Medicaid and the Uninsured and the Assessing the New Federalism Project. Any views expressed are those of the authors and should not be attributed to the Urban Institute, its board, or its funders.
Effects of Medicaid Managed Care Programs on Health Services Access and Use
Article first published online: 30 APR 2003
Health Services Research
Volume 38, Issue 2, pages 575–594, April 2003
How to Cite
Garrett, B., Davidoff, A. J. and Yemane, A. (2003), Effects of Medicaid Managed Care Programs on Health Services Access and Use. Health Services Research, 38: 575–594. doi: 10.1111/1475-6773.00134
- Issue published online: 30 APR 2003
- Article first published online: 30 APR 2003
- managed care;
- primary care case management;
- health care access
Objective. To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees’ access to and use of health care services at the national level.
Data Sources/Study Setting 1991–1995 National Health Interview Surveys (NHIS) and a 1998 Urban Institute survey on state Medicaid managed care programs.
Study Design. Using multivariate regression models, we estimated the effect of living in a county with an MMC program on several access and use measures for nonelderly women who receive Medicaid through AFDC and child Medicaid recipients. We focus on mandatory programs and estimate separate effects for primary care case management (PCCM) programs, health maintenance organization (HMO) programs, and mixed PCCM/HMO programs, relative to fee-for-service (FFS) Medicaid. We control for individual and county characteristics, and state and year effects.
Data Collection/Extraction Method. This study uses pooled individual-level data from up to five years of the NHIS (1991–1995), linked to information on Medicaid managed care characteristics at the county level from the 1998 MMC survey.
Principal Findings We find virtually no effects of mandatory PCCM programs. For women, mandatory HMO programs reduce some types of non–emergency room (ER) use, and increase reported unmet need for medical care. The PCCM/HMO programs increase access, but had no effects on use. For children, mandatory HMO programs reduce ER visits, and increase the use of specialists. The PCCM/HMO programs reduce ER visits, while increasing other types of use and access.
Conclusions Mandatory PCCM/HMO programs improved access and utilization relative to traditional FFS Medicaid, primarily for children. Mandatory HMO programs caused some access problems for women.