Sage Journals: Discover world-class research

Abstract

Managed care is now the norm for many on Medicaid, with approximately 19 million people on Medicaid enrolled in health maintenance organizations. In 2005, nearly 300 plans nationwide participated in state Medicaid managed care programs, with many of those plans operating under for-profit ownership. Concerns about the impact of plan ownership on access to care arise because of differences in the incentives in place in for-profit and nonprofit organizations that may lead for-profit plans to restrict access to care. Using data from the 2002 National Survey of America's Families on plan enrollment for a national sample of Medicaid enrollees, this study examines the link between for-profit plan ownership and enrollees' access to health care. The results suggest that access to care for Medicaid enrollees may be better under nonprofit plans than for-profit plans.

Keywords

Medicaid managed care HMOs for-profit

Get full access to this article

View all access options for this article.

References

Andersen, R. (1995). Revisiting the behavioral model of access to medical care: Does it matter? Journal of Human and Social Behavior , 36, 1-10.

Andersen, R.M. , & Newman, J.F. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly, 51(1), 95-124.

Bloom, J.R. , Hu, T.W. , Wallace, N. , Cuffel, B. , Hausman, J.W. , Sheu, M.L. , et al. (2002). Mental health costs and access under alternative capitation systems in Colorado. Health Services Research, 37, 315-340.

Brick, J.M. , Ferraro, D. , & Strickler, T. (2004). Variance estimation for the 2002 NSAF. 2002 NSAF Methodology Report No. 4. Retrieved March 20, 2008, from http://www.urban.org/center/anf/2002methodology.cfm

Centers for Medicare and Medicaid Services. ( 2005). National summary of Medicaid managed care programs and enrollment as of June 30, 2005. Retrieved March 20, 2008, from www.cms.hhs.gov/MedicaidDataSourcesGenInfo/Downloads/mmcer05.pdf

Flores, G. , Abreu, M. , Sun, D. , & Tomany, S.C. (2004). Urban parents' knowledge and practices regarding managed care. Medical Care, 42, 336-345.

Hill, S.C. , Thornton, C. , Trenholm, C. , & Wooldridge, J. (2002). Risk selection among SSI enrollees in TennCare. Inquiry, 39, 152-167.

McClellan, M.B. , & Newhouse, J.P. (2000). Overview of the special supplement issue. Health Services Research, 35, 1061-1069.

Reschovsky, J.D. , & Hargraves, J.L. (2000). Health care perceptions and experiences: It's not whether you are in an HMO, it's whether you think you are [Issue Brief, No. 30]. Washington, DC: Center for Health System Change.

10.

Schlesinger, M. , Mitchell, S. , & Gray, B. (2003). Measuring community benefits provided by nonprofit and for-profit HMOs. Inquiry, 40(Summer), 114-132.

11.

Schlesinger, M. , Quon, N. , Wynia, M. , Cummins, D. , & Gray, B. (2005). Profit-seeking, corporate control, and the trustworthiness of health care organizations: Assessments of health plan performance by their affiliated physicians. Health Services Research, 40, 274-486.

12.

Shenkman, E. , Wu, S.S. , Nackashi, J. , & Sherman, J. (2003). Managed care organizational characteristics and health care use among children with special health care needs. Health Services Research, 38, 1599-1624.

13.

StataCorp. (2007). Stata statistical software: Release 10. College Station, TX: StataCorp LP.

14.

Wooldridge, J. (2002). Econometric analysis of cross section and panel data. Cambridge, MA: MIT Press.

Do For-Profit Health Plans Restrict Access to Care Under Medicaid Managed Care?

Abstract

Keywords

Get full access to this article

References