Lack of insurance and living in an area with greater managed care activity reduce access to care

2003 ◽  
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Care Activity

Plan Choice and Changes in Access to Care over Time for SSI-Eligible Children with Disabilities

2005 ◽  
Vol 42 (2) ◽  
pp. 145-159 ◽  
Author(s):  
Pamela N. Roberto ◽  
Jean M. Mitchell ◽  
Darrell J. Gaskin
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Estimation Procedure ◽  
Care Plan ◽  
Care Hospital ◽  
Fee For Service ◽  
Special Needs Children ◽  
Plan Choice ◽  
Two Step Estimation ◽  
Over Time

This paper analyzes how voluntary enrollment in the fee-for-service (FFS) system versus a partially capitated managed care plan affects changes in access to care over time for special needs children who receive Supplemental Security Income (SSI) due to a disability. Four indicators of access are evaluated, including specialty care, hospital care, emergency care, and access to a regular doctor. We employ the Heckman two-step estimation procedure to correct for the potential nonrandom selection bias linked to plan choice. The findings show that relative to their counterparts in the partially capitated managed care plan, SSI children enrolled in the FFS plan are significantly more likely to encounter an access problem during either of the time periods studied. Similarly, FFS enrollees are significantly more likely than partially capitated managed care participants to experience persistent access problems across three of the four dimensions of care. Possible explanations for the deterioration in access associated with FFS include the lack of case management services, lower reimbursement relative to the partially capitated managed care plan, and provider availability.

Does Medicaid Managed Care Affect Access To Care For The Uninsured?

2005 ◽  
Vol 24 (4) ◽  
pp. 1095-1105 ◽  
Author(s):  
Jessica E. Haberer ◽  
Bowen Garrett ◽  
Laurence C. Baker
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Medicaid Managed Care

Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

2008 ◽  
Vol 45 (4) ◽  
pp. 395-407 ◽  
Author(s):  
Teresa A. Coughlin ◽  
Sharon K. Long ◽  
John A. Graves
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Control Program ◽  
National Study ◽  
Fee For Service ◽  
Pooled Data ◽  
Medicaid Beneficiaries ◽  
Program Costs

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.

scholarly journals Managed Care and Health Care Expenditures: Evidence from Medicare, 1990-1994

1998 ◽  
Vol 1 (1) ◽  
Author(s):  
Laurence C. Baker ◽  
Sharmila Shankarkumar
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Market Share ◽  
Health Care Policy ◽  
Care Delivery ◽  
Health Care Expenditures ◽  
Spillover Effects ◽  
Fee For Service ◽  
Health Care Market ◽  
Care Activity

Increases in the activity of managed care organizations may have "spillover effects," influencing the entire health care delivery system's performance, so that care for both managed-care and non–managed-care patients is affected. Some proposals for Medicare reform have incorporated spillover effects as a way that increasing Medicare HMO enrollment could contribute to savings for Medicare.This paper investigates the relationship between HMO market share and expenditures for the care of beneficiaries enrolled in traditional fee-for-service Medicare. We find that increases in systemwide HMO market share (which includes both Medicare and non-Medicare enrollment) are associated with declines in both Part A and Part B fee-for-service expenditures. The fact that managed care can influence expenditures for this population, which should be well insulated from the direct effects of managed care, suggests that managed-care activity can have broad effects on the entire health care market. Increases in Medicare HMO market share alone are associated with increases in Part A expenditures and with small decreases in Part B expenditures. This suggests that any spillovers directly associated with Medicare HMO enrollment are small.For general health care policy discussions, these results suggest that assessment of new policies that would influence managed care should account not only for its effects on enrollees but also for its systemwide effects. For Medicare policy discussions, these findings imply that previous results that seemed to show large spillover effects associated with increases in Medicare HMO market share, but inadequately accounted for systemwide managed-care activity and relied on older data, overstated the magnitude of actual Medicare spillovers.

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