How well does Medicaid work in improving access to care?
OBJECTIVE
To provide an assessment of how well the Medicaid program is working at improving access to and use of health care for low-income mothers.


METHODS
The 1997 and 1999 National Survey of America's Families, with state and county information drawn from the Area Resource File and other sources.


METHODS
Estimate the effects of Medicaid on access and use relative to private coverage and being uninsured, using instrumental variables methods to control for selection into insurance status.


METHODS
This study combines data from 1997 and 1999 for mothers in families with incomes below 200 percent of the federal poverty level.


RESULTS
We find that Medicaid beneficiaries' access and use are significantly better than those obtained by the uninsured. Analysis that controls for insurance selection shows that the benefits of having Medicaid coverage versus being uninsured are substantially larger than what is estimated when selection is not accounted for. Our results also indicate that Medicaid beneficiaries' access and use are comparable to that of the low-income privately insured. Once insurance selection is controlled for, access and use under Medicaid is not significantly different from access and use under private insurance. Without controls for insurance selection, access and use for Medicaid beneficiaries is found to be significantly worse than for the low-income privately insured.


CONCLUSIONS
Our results show that the Medicaid program improved access to care relative to uninsurance for low-income mothers, achieving access and use levels comparable to those of the privately insured. Our results also indicate that prior research, which generally has not controlled for selection into insurance coverage, has likely understated the gains of Medicaid relative to uninsurance and overstated the gains of private coverage relative to Medicaid.
Long
Sharon K
SK
Health Policy Center, The Urban Institute, Washington, DC 20037, USA.
Coughlin
Teresa
T
King
Jennifer
J
D000328:Adult; D001294:Attitude to Health; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage; D016018:Least-Squares Analysis; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration*; D009035:Mothers; D011203:Poverty; D014481:United States