 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
David M. Mosen, PhD1, Matthew J. Carlson, PhD1, and Cindy Fessler, BA2. (1) Department of Public Health and Preventive Medicine, CareOregon and Oregon Health & Science University, 522 SW Fifth Ave, Suite 200, Portland, OR 97204, (503) 762-5350, david.mosen@kp.org, (2) Research and Evaluation, CareOregon, 522 SW 5th Avenue, Suite 200, Portland, OR 97236
Background. There is very little research examining the impact of consumers’ experiences with their care on health services utilization, especially among Medicaid recipients.
Objectives. This study examines the influence of predisposing, enabling and need characteristics on patient ratings of their health care and the net impact of patient characteristics and health care ratings on utilization of preventive, outpatient, and emergency room (ER) utilization in a 6 month period following survey administration.
Research Design. This longitudinal study uses the Consumer Assessment of Health Plans Survey merged with health care claims data covering utilization six months before and six months following the survey.
Subjects. A random sample of 570 (response rate=57%) child Medicaid recipients from the largest Medicaid managed care health plan in Oregon.
Measures. Consumer experiences were measured using CAHPS composites: Getting Needed Care; Getting Care Without a Long Wait; overall Health Care Rating, Specialist Rating, Health Plan Rating and Regular Physician Rating. Health care utilization from claims data included number of visits for preventive, and outpatient care, and ER utilization.
Findings. Hispanics rated less favorably their access to care relative to Whites. Regular physician was related to patient ratings and to utilization, and health status was also related to patient ratings. Those with a regular physician and those with good to excellent health status rated their access to care more favorably than those without physicians, and who were in poor to fair health status. In multivariate logistic regression models predicting emergency room utilization only prior utilization (OR=2.22), male gender (OR=1.80), regular physician (O.R.=1.86), child’s age (O.R.=0.91) and high ratings of health plan (OR=2.85) were significant.
Conclusions. Hispanics in this sample did not report better access to care than whites. This contradicts recent research suggesting that racial disparities in access to care may be less pronounced in Medicaid compared with commercial populations. Ratings of health care, regular physician, and health plan predicted preventive visits, lending support to the hypothesis that favorable ratings of care positively influence health care utilization. This is true for rating of specialist and emergency department utilization. Individuals who received care in the ER and had a more positive experience than those most likely to return to the ER for care.
Learning Objectives:
Keywords: Access to Care, Patient Satisfaction
Presenting author's disclosure statement:
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.