Managed care and low-income populations: recent state experiences

Published on May 1, 1998in Health Affairs5.71
· DOI :10.1377/hlthaff.17.3.238
Marsha Lillie-Blanton21
Estimated H-index: 21
(Johns Hopkins University),
Barbara Lyons9
Estimated H-index: 9
(Johns Hopkins University)
ABSTRACT: This DataWatch examines the relationship between managed care enrollment and access to care for low-income adults with Medicaid and compares their experience with that of low-income, privately insured managed care enrollees. Medicaid managed care enrollees are more likely than low-income, privately insured managed care enrollees to be poorer, have health problems, and experience access problems. Compared with low-income populations in fee-for-service care, managed care enrollees, whether in Medicaid or privately insured, are not appreciably different in having a usual source of care, having a regular provider, or emergency room use but report more problems in obtaining care and are more likely to be dissatisfied with their health plans.
  • References (3)
  • Citations (38)
Published on Sep 1, 1997in Health Affairs5.71
Cathy Schoen31
Estimated H-index: 31
(Commonwealth Fund),
Barbara Lyons4
Estimated H-index: 4
(Kaiser Family Foundation)
+ 2 AuthorsElaine Puleo34
Estimated H-index: 34
(UMass: University of Massachusetts Amherst)
Using survey data from 2,000 low-income adult respondents in each of five states, this DataWatch assesses how uninsured, low-income adults differ from low-income adults who have public or private insurance and how Medicaid expansions have affected insurance coverage patterns across states with different eligibility policies. Findings show that the proportion of low-income uninsured adults is two to three times higher in states that have not expanded Medicaid eligibility beyond relatively low wel...
Published on Jan 1, 1995in Health Affairs5.71
Karen D. Davis75
Estimated H-index: 75
(Rice University),
Karen Scott Collins3
Estimated H-index: 3
(Rice University)
+ 1 AuthorsCynthia Morris1
Estimated H-index: 1
(Rice University)
Prologue: Despite the failure of government to act on comprehensive health system reform, the US, health care system is undergoing rapid and profound changes. Managed care plans continue to gain a foothold throughout the country. The security of many Americans' health care rises and falls with the fortunes of the U.S. economy, both here and abroad, because health care coverage is inextricably linked to employment status. Public programs such as Medicare and Medicaid are under unprecedented scrut...
John W. Bluford1
Estimated H-index: 1
While managed care is still a new concept in much of the country, it has been a reality in the Minneapolis-St. Paul area for more than three decades. Metropolitan Health Plan (MHP), a public-sector, county-owned health maintenance organization (HMO), was developed 10 years ago as a mechanism to ensure retention of the county hospital's historical patient base if the state of Minnesota were to mandate managed care for public-assistance patients (which occurred in 1985). Because MHP's chief provid...
Cited By38
Published on Jul 1, 2007in Journal of Health Services Research & Policy2.30
Jonathan B. VanGeest17
Estimated H-index: 17
(KSU: Kennesaw State University),
Saul Weiner2
Estimated H-index: 2
(UIC: University of Illinois at Chicago)
+ 1 AuthorsDeborah S. Cummins9
Estimated H-index: 9
(UIC: University of Illinois at Chicago)
Objective: To develop and test an explanatory model of the impact of managed care on physicians' decisions to manipulate reimbursement rules for patients.Methods: A self-administered mailed questionnaire of a national random sample of 1124 practicing physicians in the USA. Structural equation modelling was used. The main outcome measure assessed whether or not physicians had manipulated reimbursement rules (such as exaggerated the severity of patients conditions, changed billing diagnoses, or re...
Published on Feb 1, 2007in Health Services Research2.71
Benjamin Lê Cook22
Estimated H-index: 22
(Mathematica Policy Research)
There is substantial evidence of racial disparities in health care access and utilization. Hispanics and African Americans are less likely than whites to have a regular primary care provider, and more likely to report emergency room (ER) use (Collins, Hall, and Neuhaus 1999). African Americans and Hispanics are also less likely than whites to have a usual source of care and to have a health care visit in the last year, disparities that persist even after controlling for poverty status (Kaiser Fa...
Published on Jan 1, 2007
Daniel Simonet9
Estimated H-index: 9
(NTU: Nanyang Technological University)
The objective of the paper is to appraise of US experience of Managed Care according to the WHO evaluation grid. In the mid 1990s, HMOs organizations gained an increasing share of the US health care market by recruiting a growing number of US citizens. After a short review of history, Managed Care will be evaluated according to the WHO evaluation grid that uses criteria such as equity, quality, efficiency, and relevancy. Quality and efficiency appear unchanged under Managed Care. Health care pri...
Published on Jan 1, 2006
A digital information reproducing apparatus in accordance with a prior art that uses a semiconductor memory to realize a memory means cannot reproduce digital data which has been encoded according to a compression coding form different from the one adopted by an incorporated decoding circuit. According to the present invention, a decoding program stored in a second semiconductor memory is selected according to a compression coding form adopted for digital data stored in a first semiconductor mem...
Daniel Simonet9
Estimated H-index: 9
(NTU: Nanyang Technological University)
Purpose – In the USA, health maintenance organizations (HMOs) have pledged to control health care costs. Many patients have complained about the quality of care under the HMO regime and limits imposed on them, particularly access to care. Has quality of care been degraded under the HMO regime, resulting in an impact on patient satisfaction? There have been many studies that have compared the satisfaction of HMO patients with that of patients in the traditional fee‐for‐service payment system. The...
Published on Jun 15, 2005in Health Services Research2.71
Shannon Gwin Mitchell9
Estimated H-index: 9
Mark Schlesinger35
Estimated H-index: 35
Objective To determine whether gender differences in reports of problematic health care experiences are associated with characteristics of managed care.
Daniel Simonet9
Estimated H-index: 9
(NTU: Nanyang Technological University)
After an historical review of the advent of managed care in the USA, this article presents cost-control mechanisms, changes in the medical practice and consequences on patient health. The article also explains the development of the HMO using the transaction costs theory and the subsequent orientations of the US health care system. Copyright © 2005 John Wiley & Sons, Ltd.
Carmen E. Albizu-García8
Estimated H-index: 8
(UPR: University of Puerto Rico),
Ruth Ríos5
Estimated H-index: 5
(UPR: University of Puerto Rico)
+ 1 AuthorsMargarita Alegría66
Estimated H-index: 66
(UPR: University of Puerto Rico)
The present study examines the extent of turnover in mental health provider networks within public sector managed mental health care over a 1-year period and its association to provider and practice characteristics. Telephone interviews were conducted with a sample of mental health services providers listed the previous year in the networks of the 3 public sector managed mental health care organizations operating in Puerto Rico. Thirty-one percent of respondents had dropped out of networks. The ...
Published on Jun 1, 2004in Health Services Research2.71
Jayasree Basu15
Estimated H-index: 15
Bernard Friedman11
Estimated H-index: 11
Helen Burstin42
Estimated H-index: 42
Despite the rapid growth in Medicaid managed care (MMC) during the 1990s, there are limited data about the impact of managed care on Medicaid beneficiaries. Although managed care has been shown to improve access to primary care in some communities (e.g., Mitchell et al. 2002 ), its effect on a Medicaid population may depend on constricted levels of funding and other factors. Studies indicate that MMC may have major differences from commercial managed care (Institute of Medicine 2000). Compared w...
Published on Feb 1, 2004in Inquiry
Pamela L. Davidson20
Estimated H-index: 20
(UCLA: University of California, Los Angeles),
Ronald Andersen53
Estimated H-index: 53
+ 1 AuthorsE. Richard Brown26
Estimated H-index: 26
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 disprop...
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