title: Safety-net institutions buffer the impact of Medicaid managed care: a multi-method assessment in a rural state.
abstract: OBJECTIVE
  This project used a long-term, multi-method approach to study the impact of Medicaid managed care.
  
  
  METHODS
  Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico.
  
  
  RESULTS
  After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.34, 0.64) and worse barriers to care (OR = 6.60; 95% CI = 3.95, 11.54) than adults in other insurance categories. Medicaid children experienced greater access and use (OR = 2.11; 95% CI = 1.21, 3.72) and greater communication and satisfaction (OR = 3.64; 95% CI = 1.13, 12.54) than children in other insurance categories; uninsured children encountered greater barriers to care (OR = 6.29; 95% CI = 1.58, 42.21). There were no consistent changes in the major outcome variables over the period of transition to Medicaid managed care. Safety-net institutions experienced marked increases in workload and financial stress, especially in rural areas. Availability of mental health services declined sharply. Providers worked to buffer the impact of Medicaid managed care for patients.
  
  
  CONCLUSIONS
  In its first year, Medicaid managed care exerted major effects on safety-net providers but relatively few measurable effects on individuals. This reform did not address the problems of the uninsured.
authors.affiliation: Department of Family and Community Medicine, University of New Mexico, 2400 Tucker Avenue, Albuquerque, NM 87131, USA. waitzkin@unm.edu
authors.forename: Howard
authors.initials: H
authors.lastname: Waitzkin
authors.forename: Robert L
authors.initials: RL
authors.lastname: Williams
authors.forename: John A
authors.initials: JA
authors.lastname: Bock
authors.forename: Joanne
authors.initials: J
authors.lastname: McCloskey
authors.forename: Cathleen
authors.initials: C
authors.lastname: Willging
authors.forename: William
authors.initials: W
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000884:Anthropology, Cultural; D002648:Child; D005191:Family Characteristics / Q000208:ethnology; D005260:Female; D018166:Health Care Reform; D019538:Health Care Surveys / Q000379:methods; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D009516:New Mexico / Q000453:epidemiology; D017060:Patient Satisfaction / Q000208:ethnology*; D011203:Poverty / Q000208:ethnology; D015397:Program Evaluation; D012423:Rural Health; D013221:State Health Plans / Q000458:organization & administration* / Q000706:statistics & numerical data; D013689:Telephone; D017664:Uncompensated Care / Q000706:statistics & numerical data*; D014481:United States