title: Managed care penetration, insurance status, and access to health care.
abstract: BACKGROUND
  Access to health care, reflected by an ability to meet one's health needs, is influenced by individual characteristics and the environment. Although managed care activity influences healthcare prices and overall utilization, its relationship to access and its broader effects across different insurance categories has not been well studied.
  
  
  OBJECTIVE
  To examine the association between managed care activity and individuals' access to care, and to assess differences in this relationship by insurance status.
  
  
  METHODS
  Cross-sectional survey of households conducted in 1998.
  
  
  METHODS
  A sample of 15,613 adult Ohio residents.
  
  
  METHODS
  Self-reported difficulties in obtaining health care, medications, supplies, or medical equipment in the past year.
  
  
  RESULTS
  A total of 1248 (8.0%) identified an access problem. In bivariate analyses, these problems were more common among continuously and intermittently uninsured individuals compared with those who were continuously insured during the previous 12 months (P<0.001) and also among those living in areas with more managed care (P=0.01). After accounting for other individual and environmental characteristics in hierarchical analyses, individuals residing in areas with more managed care had 28% higher odds of reporting problems obtaining care than those elsewhere (multivariate odds ratio, 1.28; 95% confidence interval, 1.04-1.58]; P=0.02). No significant interaction between managed care penetration and insurance status was observed.
  
  
  CONCLUSIONS
  Greater managed care activity is associated with unfavorable patterns of healthcare access despite an individual's insurance status, suggesting more pervasive effects. Unintended effects should be carefully evaluated when formulating future programs that seek to address disparities in access to care.
authors.affiliation: Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106-6033, USA. Wrightlit@aol.com
authors.forename: David
authors.initials: D
authors.lastname: Litaker
authors.forename: Randall D
authors.initials: RD
authors.lastname: Cebul
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D016015:Logistic Models; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009820:Ohio; D011177:Postal Service; D012111:Residence Characteristics