title: Access, satisfaction, and utilization in two forms of Medicaid managed care.
abstract: We determined access and satisfaction of 2,598 recipients of Virginia's Medicaid program, comparing its health maintenance organizations (HMOs) to its primary care case management (PCCM) program. Positive responses were summed as sub-domains either of access, satisfaction, or of utilization, and adjusted odds ratios were calculated for HMO (vs. PCCM) sub-domain scores. The response rate was 47 per cent. We found few significant differences in perceived access, satisfaction, and utilization. Both HMO adults and children more often perceived good geographic access (adults, OR, [CI] = 1.50, [1.04-2.16]; children, OR, [CI] = 1.773 [1.158, 2.716]). But HMO patients less often reported good after-hours access (adults, OR, [CI] = 0.527 [0.335, 0.830]; children, OR, [CI] = 0.583 [0.380, 0.894]). Among all patients reporting poorer function, HMO patients more often reported good general and preventive care (OR, [CI] = 2.735 [1.138, 6.575]). We found some differences between Medicaid HMO versus PCCM recipients' reported access, satisfaction, and utilization, but were unable to validate concerns about access and quality under more restrictive forms of Medicaid managed care.
authors.affiliation: Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Smith
authors.forename: J J
authors.initials: JJ
authors.lastname: Cotter
authors.forename: D K
authors.initials: DK
authors.lastname: McClish
authors.forename: V E
authors.initials: VE
authors.lastname: Bovbjerg
authors.forename: L F
authors.initials: LF
authors.lastname: Rossiter
mesh_terms: D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000458:organization & administration / Q000592:standards*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D013221:State Health Plans / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States; D014768:Virginia