Caregivers' ratings of access: do children with special health care needs fare better under fee-for-service or partially capitated managed care?
OBJECTIVE
The objective of this study was to evaluate how enrollment in a partially capitated managed care (MC) option versus the fee-for-service (FFS) system affects caregivers' ratings of dimensions of access to services among children with special health care needs (SHCN).


METHODS
The data were collected from telephone interviews during the summer and fall of 2002 with a random sample of 1088 caregivers of children with SHCN who qualified for Supplemental Security Income and therefore were enrolled the Medicaid program for children with SHCN in the District of Columbia.


METHODS
We used a 2-step procedure in which we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias linked to plan choice. We estimated the second stage equations predicting caregiver's ratings of dimensions of access as a function of the selectivity correction, the plan choice dummy variable and other exogenous variables.


RESULTS
After controlling for the potential selection bias linked to plan choice and other confounding factors, we find that caregivers of children in FFS are significantly more likely than caregivers of children enrolled in the partially capitated MC plan to rate the following dimensions of access as either fair or poor: "access to specialists' care" (P < 0.01), "access to emergency room care" (P < 0.01), "convenience of the doctor's office" (P < 0.01), and "waiting time between making the appointment actual visit" (P < 0.05).


CONCLUSIONS
We attribute these differences in caregivers' ratings of dimensions of access that exist between partially capitated MC and FFS enrollees to case management and care coordination services along with higher fees paid for pediatrician's and specialists' services available under MC option.
Mitchell
Jean M
JM
Georgetown Public Policy Institute, Washington, DC, USA. mitchejm@georgetown.edu
Gaskin
Darrell J
DJ
D002204:Capitation Fee / Q000458:organization & administration*; D017028:Caregivers; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D019988:Children with Disabilities; D018588:Fee-for-Service Plans / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration