Factors affecting plan choice and unmet need among supplemental security income eligible children with disabilities.
OBJECTIVE
To evaluate factors affecting plan choice (partially capitated managed care [MC] option versus the fee-for-service [FFS] system) and unmet needs for health care services among children who qualified for supplemental security income (SSI) because of a disability.


METHODS
We conducted telephone interviews during the summer and fall of 2002 with a random sample of close to 1,088 caregivers of SSI eligible children who resided in the District of Columbia.


METHODS
We employed a two-step procedure where we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias associated with plan choice. We included the selectivity correction, the dummy variable indicating plan choice and other exogenous regressors in the second stage equations predicting unmet need. The dependent variables in the second stage equations include: (1) having an unmet need for any service or equipment; (2) having an unmet need for physician or hospital services; (3) having an unmet need for medical equipment; (4) having an unmet need for prescription drugs; (5) having an unmet need for dental care.


RESULTS
More disabled children (those with birth defects, chronic conditions, and/or more limitations in activities of daily living) were more likely to enroll in FFS. Children of caregivers with some college education were more likely to opt for FFS, whereas children from higher income households were more prone to enroll in the partially capitated MC plan. Children in FFS were 9.9 percentage points more likely than children enrolled in partially capitated MC to experience an unmet need for any type of health care services (p<.01), while FFS children were 4.5 percentage points more likely than partially capitated MC enrollees to incur a medical equipment unmet need (p<.05). FFS children were also more likely than partially capitated MC enrollees to experience unmet needs for prescription drugs and dental care, however these differences were only marginally significant.


CONCLUSIONS
We speculate that the case management services available under the MC option, low Medicaid FFS reimbursements and provider availability account for some of the differences in unmet need that exist between partially capitated MC and FFS enrollees.
Mitchell
Jean M
JM
Georgetown Public Policy Institute, 3520 Prospect St. NW, Room 423, Washington, DC 20007, USA.
Gaskin
Darrell J
DJ
D000293:Adolescent; D002204:Capitation Fee; D002648:Child; D002662:Child Health Services / Q000145:classification / Q000191:economics*; D002675:Child, Preschool; D003258:Consumer Behavior / Q000191:economics / Q000706:statistics & numerical data*; D019988:Children with Disabilities; D004219:District of Columbia; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008484:Medicaid / Q000458:organization & administration*; D009939:Organizations, Nonprofit / Q000191:economics*; D012943:Social Security