Coulam RF, Kidder DE, Irvin CV, Calore KA, Rosenbach ML.
AHSR FHSR Annu Meet Abstr Book. 1996; 13: 23-24.
Abt Assoc. Inc., Cambridge, MA 02138 USA.
RESEARCH OBJECTIVE: Fears have been expressed that Medicaid capitated managed care -- necessary to control costs -- will limit the access of Medicaid beneficiaries to needed care. The purpose of this study was to test a contrasting possibility: that an HMO's ability to manage care might be used to improve access. STUDY POPULATION: The study population included children up to 185% of poverty (FPL) in the public schools of Volusia County, Florida, who enrolled in the Florida Healthy Kids (FHK) demonstration, an OBRA 1989 demonstration to test innovative extensions of Medicaid eligibility to children. FHK contracted with a staff-model HMO to provide demonstration coverage. School-age enrollees in standard commercial products of the HMO provided one comparison group for this study. In addition, demonstration enrollees were compared to a comparable group of non-demonstration enrollees on measures of access, utilization, and satisfaction. STUDY DESIGN: Utilization data from the HMO were broken down by age and sex for commercial and FHK enrollees. These data were used for univariate demonstration-comparison analyses of FHK enrollees versus commercial enrollees of the HMO. The research team performed linear fixed-effects analyses of access, utilization, and satisfaction, based on two waves of surveys of enrollees and comparable non-enrollees. Extensive interviews with demonstration and provider staff were used to understand the problems of implementing school-based coverage and to interpret quantitative results. PRINCIPAL FINDINGS: The Florida Healthy Kids demonstration reduced the number of uninsured students in Volusia County by roughly one-quarter to one-half and schools were determined to be an effective medium for marketing health coverage. Meanwhile, utilization and cost levels for poor and near-poor enrollees proved to be indistinguishable from levels for the HMO's commercial clients; and measures of access, utilization, and satisfaction for enrollees were in line with (and in some cases, superior to) non-enrollees with private insurance. The HMO was able to reduce its premium by 22% in the course of the demonstration. CONCLUSIONS: The best explanation for these results lies in steps taken by the HMO to reduce non-financial barriers to care (e.g. providers on call 24 hours, walk-in clinics with extended hours, and education about avoiding ER use). Financial deterrents to particularly costly forms of utilization (e.g. co-payments for emergency room visits) have actually been reduced in the course of the demonstration. Florida has extended the FHK model to other couties in the state. RELEVANCE TO CLINICAL PRACTICE AND POLICY: An official at the Florida HMO noted: "If you treat [the demonstration kids] like commercial clients, they behave like commercial clients." These results suggest the value of managing access for uninsured populations, that is, taking deliberate steps to reduce the non-financial barriers to care, rather than focusing on financial barriers alone.
Publication Types:
Keywords:
- Child
- Child Health Services
- Eligibility Determination
- Florida
- Health Maintenance Organizations
- Health Personnel
- Health Services Needs and Demand
- Humans
- Managed Care Programs
- Medicaid
- Medically Uninsured
- Poverty
- Schools
- Teaching
- economics
- utilization
- hsrmtgs
Other ID:
UI: 102222137
From Meeting Abstracts