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APHA Scientific Session and Event Listing

Michael E. Martinez, MPH, MHSA, National Center for Health Statistics, 3311 Toledo Rd. Room 2332, Hyattsville, MD 20782, 301-458-4758, bmd7@cdc.gov and Robin A. Cohen, PhD, National Center for Health Statistics, CDC, 3311 Toledo Road, Room 2122, Hyattsville, MD 20782.

There is much concern about the quality and delivery of healthcare services for persons covered by managed care and those covered by government sponsored health plans like Medicaid. This paper explores differences in access to health care for working-age adults with private and Medicaid coverage under managed care (MC) and fee-for-service (FFS) plans. Persons with no insurance are included in the analysis for comparison purposes.

This study uses the 2004 National Health Interview Survey (NHIS), which is a nationally representative sample of the U.S. civilian noninstitutionalized population and is conducted as a face-to-face household interview. Data are derived from the Family Core component, which collects information on all family members in each household and the Sample Adult component of the NHIS, where one adult is selected per family and asked additional questions. The study population includes 25,307 sample adults 18-64 years of age who provided information about their health.

Health outcome measures include flu/pneumoccal vaccinations, visits to doctors' offices, dental visits, use of medical specialists, unmet medical needs due to cost, and non-medical barriers to receiving care. Unmet medical needs is a composite variable that includes the following: delay or did not obtain needed care due to cost, needed prescription medication, mental health services, dental care or eyeglasses in the past year but did not get these services due to cost. Non-medical barriers to care include not being able to get through on the phone, difficulty obtaining an appointment, long waits in the doctor's office, inconvenient office hours and lack of transportation. Selected socio-demographic variables such as race/ethnicity, sex, poverty, and educational level are also examined.

Working-age adults with MC are more likely to have a regular source of medical care and report a non-medical barrier to receiving health care than those with FFS plan. Ninety-two percent of persons covered by Private MC have a regular source of care compared with 89%, 89% and 85% for Private FFS, Medicare MC, and Medicare FFS, respectively. Comparatively 47% of people who are uninsured have a regular source of care. Ten percent covered by Private MC had a non-medical barrier to care compared with 9%, 18%, and 14% for Private FFS, Medicare MC, and Medicare FFS, respectively.

Learning Objectives:

• Audience will be able to understand the impact of managed care on utilization of health services.

Presenting author's disclosure statement:

Any relevant financial relationships? No