Multimethod evaluation of health policy change: an application to Medicaid managed care in a rural state.
OBJECTIVE
To answer questions about the impacts of Medicaid managed care (MMC) at the individual, organizational/community, and population levels of analysis.


METHODS
Multimethod approach to study MMC in New Mexico, a rural state with challenging access barriers.


METHODS
Individual level: surveys to assess barriers to care, access, utilization, and satisfaction. Organizational/community level: ethnography to determine changes experienced by safety net institutions and local communities. Population level: analysis of secondary databases to examine trends in preventable adverse sentinel events.


METHODS



METHODS
multivariate statistical methods, including factor analysis and logistic regression. Ethnography: iterative coding and triangulation to assess documents, field observations, and in-depth interviews. Secondary databases: plots of sentinel events over time.


RESULTS
The survey component revealed no consistent changes after MMC, relatively favorable experiences for Medicaid patients, and persisting access barriers for the uninsured. In the ethnographic component, safety net institutions experienced increased workload and financial stress; mental health services declined sharply. Immunization rate, as an important sentinel event, deteriorated.


CONCLUSIONS
MMC exerted greater effects on safety net providers than on individuals and did not address problems of the uninsured. A multimethod approach can facilitate evaluation of change in health policy.
Waitzkin
Howard
H
Department of Sociology, Family & Community Medicine, University of New Mexico, MSC 053080, 1070 Social Sciences Building, 1915 Roma NE, Room 1103, Albuquerque, NM 87131-0001, USA. waitzkin@unm.edu
Schillaci
Michael
M
Willging
Cathleen E
CE
D019538:Health Care Surveys / Q000706:statistics & numerical data; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D017057:Medically Uninsured; D009516:New Mexico; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D013221:State Health Plans / Q000458:organization & administration; D014481:United States