Cantor JC, DeLia D, Sandman D, Schoen C; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1998; 15: 238-9.
United Hospital Fund, New York, NY 10118, USA.
RESEARCH OBJECTIVES: Over 400,000 Medicaid recipients in New York City have voluntarily enrolled in managed care, and mandatory managed care enrollment will be phased in over three years for approximatey 800,000 more beneficiaries. The objectives of managed care include improving the allocation of health care resources while maintaining or improving access to care and enrollee satisfaction. We use a new cross-sectional survey of New York City residents to compare utilization, access, and satisfaction between the fee-for-service and managed care populations. We also explore the role of risk selection in the voluntary managed care program. STUDY DESIGN: The 1997 Commonwealth Fund Survey of Health Care in New York City, a cross-section of adults interviewed by telephone or in-person between October 1996 and March 1997, is analyzed to compare self-reported measures of health status, utilization, access, and satisfaction for 490 Medicaid fee-for-service (FFS) and 207 Medicaid managed care (MC) enrollees age 18-64. We also contrast responses of Medicaid beneficiaries enrolled in different types of managed care plans. Bivariate analysis is presented here and multivariate analysis in underway. PRINCIPAL FINDINGS We find few differences in utilization, access, or satisfaction between FFS and MC. However, we do find extensive risk selection. For instance, 46% of FFS enrollees rate their health status as fair or poor, compared to 30% among MC enrollees (p<0.001). FFS enrollees are also significantly more likely to report being "seriously ill" in the prior year or having had heart disease. Physician, hospital, and emergency room utilization is generally lower in MC than FFS, but these differences are not statistically significant. Utilization by the MC population is significantly more likely to have been pregnancy-related. Respondent ratings of access are similar for the FFS and MC groups, except that FFS enrollees are nearly twice as likely to have reported lacking a regular source of care (FFS=41%, MC=24%; p<0.001). Similarly, we observe few differences among twenty-two measures of satisfaction with service arrangements, with four important exceptions. FFS beneficiaries expressed significantly more dissatisfaction (fair/poor on E/G/F/P scale) with the choice of doctors available to them (FFS=31%, MC=21%; p=0.025), with out-of-pocket costs (FFS=56%, MC=36%; p<0.001), and with paperwork requirements (FFS=46%, MC=34%, p=0.048). FF beneficiaries are also more likely to have reported that a lack of coverage for needed services was a minor or major problem (FFS=15%, MC=7%; p=0.015). We did not find differences between MC enrollees in plans of different types (whether provider-sponsored and by plan size) in the measures we examined. Notably, the health status of enrollees in provider-sponsored plans was not worse than those enrolled in other (mostly commercial) managed care plans. The survey does not provide sufficient statistical power to discern differences among individual plans or among plans classified into more refined groupings. CONCLUSIONS: Voluntary enrollment has led to significant favorable selection into Medicaid managed care in New York City. It is difficult to disentangle the effects of selection from outcomes of different delivery systems in cross-sectional data. Nonetheless, despite the lower risk profile in MC, we find that MC enrollees use a similar level of medical resources and report about the same levels of access and satisfaction. In additonal analysis currently underway, we use multivariate methods to examine these outcomes while adjusting for demographic characteristics and health status. The survey showed that FFS enrollees were significantly less satisfied with choice of provider, out-of-pocket costs, and paperwork requirements. These indicators may reflect problems in the FFS program, such as arbitrary utilization limits and low provider reimbursement rates that are not as prevalent in MC. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Medicaid managed care (MMC) may achieve benefits that are not evident in enrollee self-reports (e.g., more effective allocation of resources or better clinical outcomes). However, policymakers in New York should be aware that the MMC program does not appear to improve a broad range of self-reported measures of access and satisfaction or to significantly reduce the overall use of resources. MMC is at an early stage of development in NYC, and efforts to implement the basic elements of managed care may have overshadowed steps needed to improve the measures examined in this study. Nevertheless, as more beneficiaries with low health status are subject to mandatory enrollment in managed care plans, the challenges of improving care will grow.
Publication Types:
Keywords:
- Adult
- Cross-Sectional Studies
- Data Collection
- Delivery of Health Care
- Fee-for-Service Plans
- Female
- Financial Management
- Health Services Accessibility
- Humans
- Managed Care Programs
- Medicaid
- New York
- New York City
- Pregnancy
- economics
- utilization
- hsrmtgs
Other ID:
UI: 102234429
From Meeting Abstracts