Effects of Medicaid managed care programs on health services access and use.
OBJECTIVE
To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees' access to and use of health care services at the national level.


METHODS
1991-1995 National Health Interview Surveys (NHIS) and a 1998 Urban Institute survey on state Medicaid managed care programs.


METHODS
Using multivariate regression models, we estimated the effect of living in a county with an MMC program on several access and use measures for nonelderly women who receive Medicaid through AFDC and child Medicaid recipients. We focus on mandatory programs and estimate separate effects for primary care case management (PCCM) programs, health maintenance organization (HMO) programs, and mixed PCCM/HMO programs, relative to fee-for-service (FFS) Medicaid. We control for individual and county characteristics, and state and year effects.


METHODS
This study uses pooled individual-level data from up to five years of the NHIS (1991-1995), linked to information on Medicaid managed care characteristics at the county level from the 1998 MMC survey.


RESULTS
We find virtually no effects of mandatory PCCM programs. For women, mandatory HMO programs reduce some types of non-emergency room (ER) use, and increase reported unmet need for medical care. The PCCM/HMO programs increase access, but had no effects on use. For children, mandatory HMO programs reduce ER visits, and increase the use of specialists. The PCCM/HMO programs reduce ER visits, while increasing other types of use and access.


CONCLUSIONS
Mandatory PCCM/HMO programs improved access and utilization relative to traditional FFS Medicaid, primarily for children. Mandatory HMO programs caused some access problems for women.
Garrett
Bowen
B
The Urban Institute, Health Policy Center, Washington, DC 20037, USA.
Davidoff
Amy J
AJ
Yemane
Alshadye
A
D000328:Adult; D000385:Aid to Families with Dependent Children / Q000458:organization & administration; D019090:Case Management; D002648:Child; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid / Q000458:organization & administration*; D011320:Primary Health Care; D012044:Regression Analysis; D014481:United States; D014600:Utilization Review