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

Authors

  • Howard Waitzkin,

    1. Departments of Sociology, Family & Community Medicine, and Internal Medicine, University of New Mexico, MSC 05 3080, 1070 Social Sciences Building, 1915 Roma NE, Room 1103, Albuquerque, NM 87131-0001,
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    • Address correspondence to Howard Waitzkin, M.D., Ph.D., Distinguished Professor, Departments of Sociology, Family & Community Medicine, and Internal Medicine, University of New Mexico, MSC 05 3080, 1070 Social Sciences Building, 1915 Roma NE, Room 1103, Albuquerque, NM 87131-0001; e-mail: waitzkin@unm.edu. Michael Schillaci, Ph.D., is Assistant Professor with the Department of Social Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada. Cathleen E. Willging, Ph.D., is the Research Scientist and Program Director with the Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM.

  • Michael Schillaci,

    1. Department of Social Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
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  • Cathleen E. Willging

    1. 3Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM
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Abstract

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.

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