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Park J. Medicaid managed care enrollments and potentially preventable admissions: An analysis of adult Medicaid recipients in Florida. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2019.1692994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jungwon Park
- Department of Public Administration, Andong National University, Andong, Gyeongsangbuk-do, Korea
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Sabik LM, Dahman B, Vichare A, Bradley CJ. Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care. Med Care Res Rev 2018; 77:34-45. [PMID: 29726303 DOI: 10.1177/1077558718771123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states' Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.
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Cunningham PJ, Nichols LM. The Effects of Medicaid Reimbursement on the Access to Care of Medicaid Enrollees: A Community Perspective. Med Care Res Rev 2016; 62:676-96. [PMID: 16330820 DOI: 10.1177/1077558705281061] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous research has not found a strong association between Medicaid reimbursement levels and enrollees’ access to medical care, even though higher fees increase the acceptance of Medicaid patients by physicians. This study shows that high Medicaid acceptance rates by physicians in a community are more important than fee levels per se in affecting enrollees’ access to medical care. Although high fee levels increase the probability that individual physicians will accept Medicaid patients, high fee levels do not necessarily lead to high levels of physician Medicaid acceptance in an area. Numerous other physician practice, health system, and community characteristics also affect Medicaid acceptance. The effects of Medicaid fees on Medicaid acceptance are substantially lower in areas with high Medicaid managed care penetration and for physicians who practice in institutional settings. The results suggest that a broad range of factors need to be considered to increase access to physicians for Medicaid enrollees.
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Turner LJ. The effect of Medicaid policies on the diagnosis and treatment of children's mental health problems in primary care. HEALTH ECONOMICS 2015; 24:142-157. [PMID: 24123653 DOI: 10.1002/hec.3007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 08/20/2013] [Accepted: 09/16/2013] [Indexed: 06/02/2023]
Abstract
Primary care physicians play a substantial role in diagnosing and treating children's mental health disorders, but Medicaid managed care policies may limit these physicians' ability to serve low-income children. Using data from the universe of Medicaid recipients in three states, I evaluate how Medicaid managed care policies impact primary care diagnosis and treatment of children's mental health disorders. Specific policies examined include the presence of a behavioral carve-out, traditional health maintenance organization, or primary care case management program. To alleviate concerns of endogenous patient sorting, my preferred identification strategy uses variation in Medicaid policy penetration to instrument for individual plan choices. I show that while health maintenance organizations reduce diagnosis and non-drug treatment of mental health disorders, primary care case management program policies shift in diagnosis and treatment from within primary care to specialist providers such as psychiatrists, where serious mental health conditions are more likely to be identified.
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Affiliation(s)
- Lesley J Turner
- Department of Economics, University of Maryland - College Park, College Park, MD, USA
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Lukens G. State variation in health care spending and the politics of state Medicaid policy. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2014; 39:1213-1251. [PMID: 25248962 DOI: 10.1215/03616878-2822634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study investigates the factors that underlie large variation in Medicaid and Children's Health Insurance Program (CHIP) policies among states. Both eligibility and provider payment policies are examined for low-income children and parents. I find that state variation in the cost of providing health care, due to variation in the intensity of health care use, is a key determinant of eligibility policies, and I also find tentative evidence of an effect for payment policies. Because rising health care spending increases the cost of providing health insurance coverage, state policy makers in high-spending states enact less generous Medicaid and CHIP policies. Results also indicate that the political environments of states are very important in determining their eligibility policies, but fewer political variables influence payment policies. In addition to including variables not yet examined in the context of Medicaid policy, this study uses an innovative measure of state-level health care spending and carefully constructed dependent variables that lend credibility to causal interpretations of relationships.
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Davidoff A, Hill I, Courtot B, Adams E. Are there differential effects of managed care on publicly insured children with chronic health conditions? Med Care Res Rev 2008; 65:356-72. [PMID: 18227234 DOI: 10.1177/1077558707312492] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors use variation across states and over time in managed care (MC) programs for publicly insured children to examine whether effects differ for children with chronic health conditions (CWCHC) and those without. The authors pool data from the 1997 to 2002 National Health Interview Survey and link county, year, and health status information on type of MC programs implemented. Findings show that the effects of MC are concentrated on CWCHC and that CWCHC experience reductions in use of specialist, mental health, and prescription drugs. Capitated programs with mental health or specialty carve-outs are associated with a greater number and larger decreases in service use compared to integrated capitated programs. While it is not possible to determine whether MC programs resulted in more appropriate use of services, corresponding reductions in perceived access were not observed, suggesting that net effects of MC on service use represent improvements in care coordination.
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Spitz B. Medicaid agencies as managed care organizations: an "actuarially sound" solution? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2007; 32:379-413. [PMID: 17519472 DOI: 10.1215/03616878-2007-009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Davidoff A, Hill I, Courtot B, Adams E. Effects of managed care on service use and access for publicly insured children with chronic health conditions. Pediatrics 2007; 119:956-64. [PMID: 17473097 DOI: 10.1542/peds.2006-2222] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to estimate the effects of managed care program type on service use and access for publicly insured children with chronic health conditions. METHODS Data on Medicaid and State Children's Health Insurance Program managed care programs were linked by county and year to pooled data from the 1997-2002 National Health Interview Survey. We used multivariate techniques to examine the effects of managed care program type, relative to fee-for-service, on a broad array of service use and access outcomes. RESULTS Relative to fee-for-service, managed care program assignment was associated with selected reductions in service use but not with deterioration in reported access. Capitated managed care plans with mental health or specialty carve-outs were associated with a 7.4-percentage-point reduction in the probability of a specialist visit, a 6.3-percentage-point reduction in the probability of a mental health specialty visit, and a 5.9-percentage-point decrease in the probability of regular prescription drug use. Reductions in use associated with primary care case management and integrated capitated programs (without carve-outs) were more limited, and integrated capitated plans were associated with a reduction in unmet medical care need. We failed to find significant effects of special managed care programs for children with chronic health conditions. CONCLUSIONS Managed care is associated with reduced service use, particularly when capitated programs carve out services. This finding is of key policy importance, as the proportion of children enrolled in plans with carve-out arrangements has been increasing over time. It is not possible to determine whether reductions in services represent better care management or skimping. However, despite the reductions in use, we did not observe a corresponding increase in perceived unmet need; thus, the net change may represent improved care management.
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Affiliation(s)
- Amy Davidoff
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, USA.
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Dubay L, Guyer J, Mann C, Odeh M. Medicaid At The Ten-Year Anniversary Of SCHIP: Looking Back And Moving Forward. Health Aff (Millwood) 2007; 26:370-81. [PMID: 17339663 DOI: 10.1377/hlthaff.26.2.370] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The adoption of the State Children's Health Insurance Program (SCHIP) in 1997 spurred widespread efforts to simplify and revitalize Medicaid coverage for children. To an extent often not recognized, these Medicaid improvements were a key factor behind much of the progress that has been made in covering low-income children: These children's uninsurance rate dropped from 22.3 percent in 1997 to 14.9 percent in 2005, and more than 70 percent of those gains can be attributed to Medicaid. The program, however, faces a number of issues that will need to be addressed if the country is to continue to make progress.
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Affiliation(s)
- Lisa Dubay
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Cunningham P, McKenzie K, Taylor EF. The Struggle To Provide Community-Based Care To Low-Income People With Serious Mental Illnesses. Health Aff (Millwood) 2006; 25:694-705. [PMID: 16684733 DOI: 10.1377/hlthaff.25.3.694] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This paper describes gaps in services for low-income people with serious mental illnesses as reported by mental health professionals and other observers in twelve U.S. communities. According to respondents, service gaps have grown in recent years--especially for uninsured people--as a result of state budget pressures and Medicaid cost containment policies. Growing service gaps contribute to the high prevalence of serious mental illness among the homeless and incarcerated populations, as well as crowding of emergency departments. Some states and communities are aggressively addressing these gaps, although funding for new programs remains scarce.
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Gold M, Kuo S, Taylor EF. Translating research to action: improving physician access in public insurance. J Ambul Care Manage 2006; 29:36-50. [PMID: 16340618 DOI: 10.1097/00004479-200601000-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Policymakers continue to struggle with how to assure adequate access to physician services in public programs like Medicaid, State Children's Health Insurance Program, or other public coverage programs. In this article, we synthesize available research on this topic and provide a framework that policymakers may find useful in identifying and measuring barriers to care access, determining where and why problems exist, and identifying how to intervene. Using our experience constructing the framework, we also consider what observations can be drawn from this experience for those interested in the challenge of moving the insights from research to practice.
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Affiliation(s)
- Marsha Gold
- Mathematica Policy Research Inc., Washington, DC 20036, USA.
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Long SK, Yemane A. Commercial plans in Medicaid managed care: understanding who stays and who leaves. Health Aff (Millwood) 2005; 24:1084-94. [PMID: 16012149 DOI: 10.1377/hlthaff.24.4.1084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although the rapid increase in Medicaid managed care during the early 1990s attracted commercial plans to the program, by the late 1990s commercial plan participation in Medicaid had begun to decline. This study examines the role of Medicaid policies, plan characteristics, and local health care market conditions in a commercial plan's decision to exit. We find that many of the factors that influence commercial plans' decisions to exit Medicaid are within the control of state policymakers and program administrators, including capitation rates, service carve-outs, mandatory enrollment policies, and the number of Medicaid enrollees and areas served by the plan.
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Abstract
OBJECTIVE This study examines the effects of Medicaid payment generosity on access and care for adult and child Medicaid beneficiaries. DATA SOURCE Three years of the National Surveys of America's Families (1997, 1999, 2002) are linked to the Urban Institute Medicaid capitation rate surveys, the Area Resource File, and the American Hospital Association survey files. STUDY DESIGN In order to identify the effect of payment generosity apart from unmeasured differences across areas, we compare the experiences of Medicaid beneficiaries with groups that should not be affected by Medicaid payment policies. To assure that these groups are comparable to Medicaid beneficiaries, we reweight the data using propensity score methods. We use a difference-in-differences model to assess the effects of Medicaid payment generosity on four categories of access and use measures (continuity of care, preventive care, visits, and perceptions of provider communication and quality of care). PRINCIPAL FINDINGS Higher payments increase the probability of having a usual source of care and the probability of having at least one visit to a doctor and other health professional for Medicaid adults, and produce more positive assessments of the health care received by adults and children. However, payment generosity has no effect on the other measures that we examined, such as the probability of receiving preventive care or the probability of having unmet needs. CONCLUSIONS Higher payment rates can improve some aspects of access and use for Medicaid beneficiaries, but the effects are not dramatic.
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Affiliation(s)
- Yu-Chu Shen
- Code GB, Naval Postgraduate School, 555 Dyer Road, Monterey, CA 93943, USA
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Marquis MS, Rogowski JA, Escarce JJ. The managed care backlash: did consumers vote with their feet? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2005; 41:376-90. [PMID: 15835597 DOI: 10.5034/inquiryjrnl_41.4.376] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The managed care backlash led many to predict the demise of health maintenance organizations (HMOs). This paper examines trends in HMO enrollment in all metropolitan communities from 1994 to 2000 to identify factors that led to diminishing enrollment in the backlash era and circumstances in which HMOs maintained or expanded their presence. We use a database constructed from a wide variety of sources that describe HMO penetration and other characteristics of all metropolitan statistical areas. We found the backlash is not evidenced in a large degree of consumer switching. However, HMOs were more likely to maintain their presence in areas with high-cost growth and with greater managed care experience. Medicaid HMO growth continued to expand rapidly, indicating the possibility of a two-tiered system in which low-income beneficiaries have less choice than the privately insured.
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Lagoe R, Aspling DL, Westert GP. Current and future developments in managed care in the United States and implications for Europe. Health Res Policy Syst 2005; 3:4. [PMID: 15774017 PMCID: PMC1079919 DOI: 10.1186/1478-4505-3-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Accepted: 03/17/2005] [Indexed: 11/10/2022] Open
Abstract
The paper reviews and evaluates current and future approaches to cost containment in the United States. Managed care was once seen as an effective approach to supporting health care quality while containing costs in the USA. In recent years payors started to look in other directions, since prospects for limiting expenses faded. Nowadays consumer driven health plans seem to be on the rise. The reasons for the decline of managed care, the growing popularity of the consumer driven health plans and the implications for Europe are discussed.
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Affiliation(s)
- Ronald Lagoe
- Hospital Executive Council Syracuse, NewYork, USA
| | | | - Gert P Westert
- National Institute of Public Health and the Environment Bilthoven, Netherlands
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Davidson PL, Andersen RM, Wyn R, Brown ER. A framework for evaluating safety-net and other community-level factors on access for low-income populations. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2004; 41:21-38. [PMID: 15224958 DOI: 10.5034/inquiryjrnl_41.1.21] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The framework presented in this article extends the Andersen behavioral model of health services utilization research to examine the effects of contextual determinants of access. A conceptual framework is suggested for selecting and constructing contextual (or community-level) variables representing the social, economic, structural, and public policy environment that influence low-income people's use of medical care. Contextual variables capture the characteristics of the population that disproportionately relies on the health care safety net, the public policy support for low-income and safety-net populations, and the structure of the health care market and safety-net services within that market. Until recently, the literature in this area has been largely qualitative and descriptive and few multivariate studies comprehensively investigated the contextual determinants of access. The comprehensive and systematic approach suggested by the framework will enable researchers to strengthen the external validity of results by accounting for the influence of a consistent set of contextual factors across locations and populations. A subsequent article in this issue of Inquiry applies the framework to examine access to ambulatory care for low-income adults, both insured and uninsured.
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Affiliation(s)
- Pamela L Davidson
- Department of Health Services, UCLA School of Public Health, Los Angeles, CA 90095-1772, USA.
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