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Safety-net institutions buffer the impact of medicaid managed care: A multi-method assessment in a rural state

Author

Listed:
  • Waitzkin, H.
  • Williams, R.L.
  • Bock, J.A.
  • McCloskey, J.
  • Willging, C.
  • Wagner, W.

Abstract

Objectives. This project used a long-term, multi-method approach to study the impact of Medicaid managed care. Methods. Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico. Results. After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [Cl] = 0.34, 0.64) and worse barriers to care (OR = 6.60; 95% Cl = 3.95, 11.54) than adults in other insurance categories. Medicaid children experienced greater access and use (OR = 2.11; 95% Cl = 1.21, 3.72) and greater communication and satisfaction (OR= 3.64; 95% Cl = 1.13, 12.54) than children in other insurance categories; uninsured children encountered greater barriers to care (OR = 6.29; 95% Cl = 1.58, 42.21). There were no consistent changes in the major outcome variables over the period of transition to Medicaid managed care. Safety-net institutions experienced marked increases in workload and financial stress, especially in rural areas. Availability of mental health services declined sharply. Providers worked to buffer the impact of Medicaid managed care for patients. Conclusions. In its first year, Medicaid managed care exerted major effects on safety-net providers but relatively few measurable effects on individuals. This reform did not address the problems of the uninsured.

Suggested Citation

  • Waitzkin, H. & Williams, R.L. & Bock, J.A. & McCloskey, J. & Willging, C. & Wagner, W., 2002. "Safety-net institutions buffer the impact of medicaid managed care: A multi-method assessment in a rural state," American Journal of Public Health, American Public Health Association, vol. 92(4), pages 598-610.
    • Handle: RePEc:aph:ajpbhl:2002:92:4:598-610_2
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    Cited by:

    1. Horton, Sarah, 2006. "The double burden on safety net providers: Placing health disparities in the context of the privatization of health care in the US," Social Science & Medicine, Elsevier, vol. 63(10), pages 2702-2714, November.
    2. Lindsey Woodworth, 2016. "A Leak in the Lifeboat: The effect of Medicaid managed care on the vitality of safety-net hospitals," Journal of Regulatory Economics, Springer, vol. 50(3), pages 251-270, December.
    3. Michael A Schillaci & Howard Waitzkin & E Ann Carson & Sandra J Romain, 2010. "Prenatal Care Utilization for Mothers from Low-Income Areas of New Mexico, 1989–1999," PLOS ONE, Public Library of Science, vol. 5(9), pages 1-4, September.
    4. Cheng, Tyrone, 2006. "Children's access to four medical services: Impact of welfare policies, social structural factors, and family resources," Children and Youth Services Review, Elsevier, vol. 28(6), pages 595-609, June.
    5. Abadia, Cesar Ernesto & Oviedo, Diana G., 2009. "Bureaucratic Itineraries in Colombia. A theoretical and methodological tool to assess managed-care health care systems," Social Science & Medicine, Elsevier, vol. 68(6), pages 1153-1160, March.
    6. Getrich, Christina & Heying, Shirley & Willging, Cathleen & Waitzkin, Howard, 2007. "An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention," Social Science & Medicine, Elsevier, vol. 65(2), pages 319-330, July.

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