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Managed care and low-income populations: recent state experiences

Published on May 1, 1998in Health Affairs5.711
· DOI :10.1377/hlthaff.17.3.238
Marsha Lillie-Blanton21
Estimated H-index: 21
(Johns Hopkins University),
Barbara Lyons8
Estimated H-index: 8
(Johns Hopkins University)
Abstract
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 (39)
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References3
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#1Cathy Schoen (Commonwealth Fund)H-Index: 33
#2Barbara Lyons (Kaiser Family Foundation)H-Index: 4
Last. Elaine Puleo (UMass: University of Massachusetts Amherst)H-Index: 35
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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...
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#1Karen D. Davis (Rice University)H-Index: 78
#2Karen Scott Collins (Rice University)H-Index: 3
Last. Cynthia Morris (Rice University)H-Index: 1
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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...
177 CitationsSource
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...
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Cited By39
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#2Saul J. Weiner (UIC: University of Illinois at Chicago)H-Index: 2
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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...
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#1Benjamin Lê Cook (Mathematica Policy Research)H-Index: 24
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...
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#1Daniel Simonet (NTU: Nanyang Technological University)H-Index: 9
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...
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Objective To determine whether gender differences in reports of problematic health care experiences are associated with characteristics of managed care.
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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.
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#1Carmen E. Albizu-García (UPR: University of Puerto Rico)H-Index: 9
#2Ruth Ríos (UPR: University of Puerto Rico)H-Index: 5
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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 ...
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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...
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