Medicaid programs are utilizing managed care techniques as a way to control costs while maintaining quality of care. Little is known, however, about the impact of managed care on the low-income population served by Medicaid. Access to and use of health care services by low-income children over a two-year period was assessed using data from 488 children enrolled in a longitudinal study at birth. Comparisons were made between four insurance types: Medicaid fee for service, Medicaid managed care, private insurance, and uninsured. Access and use were relatively similar for the four groups during the first year of life, although privately insured children were more likely to identify a regular site of care. Children with Medicaid fee for service differed minimally from those with Medicaid managed care except that children on managed care were less likely to have an identified provider at Year 2 than other children with insurance. Variation in the number of well-child visits by insurance type was present only in Year 2, with children enrolled in either type of Medicaid reporting more visits. Children without insurance were found to fare worse than their insured counterparts on both access and use measures. In this sample, presence or absence of insurance appeared to be the most significant predictor of access and utilization. However, results may be different in other regions of the country due to variation in Medicaid managed care plans. Future research should address the specific characteristics of health plans that impact access and use for children.
Learning Objectives: 1. Describe access to and use of health services by low-income, high-risk children in San Diego County. 2. Evaluate the impact of insurance on access and use. 3. Discuss the effect of managed care on access and use.
Keywords: Access to Health Care, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.