Medicaid recipients' experiences under mandatory managed care.
OBJECTIVE
To describe Medicaid recipients' experiences with the outcomes of access, quality, and satisfaction in a mandatory managed care (MC) program.


METHODS
A qualitative case study design with content analysis of narrative focus group (FG) data, which was part of a comprehensive program evaluation that also involved pre- and postsurveys and analyses of cost and utilization data.


METHODS
Six FG interviews were conducted in the autumn of 1997 with 31 women on the Aid to Families with Dependent Children program. Participants were recruited from a randomly ordered list of women who had responded to a 1996 premanaged care survey regarding their or their child's healthcare experiences under traditional Medicaid.


RESULTS
There was general consensus across all focus groups on a range of issues, including improvements in access to primary care and continuity of care. Overall, few participants expressed discontent with restriction of choice of provider and on MC policies regarding use of the emergency room. There was no consensus on what factors influenced choice of MC plan, although convenience of location was named most frequently. An unanticipated outcome was the recurrent theme across all focus groups of disrespectful treatment by healthcare personnel, especially under traditional Medicaid, which had declined somewhat under managed care.


CONCLUSIONS
These contextual accounts identify specific features of a mandatory Medicaid MC program that are viewed as improvements over traditional Medicaid. Specific features that were dissatisfying can be addressed to improve both enrollee satisfaction and the transition to managed care for Medicaid recipients.
Chaudry
R V
RV
Department of Political Science, University of North Carolina, Charlotte, USA.
Brandon
W P
WP
Schoeps
N B
NB
D000385:Aid to Families with Dependent Children / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D009657:North Carolina; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011787:Quality of Health Care; D014481:United States