Many policy makers have expressed concern that the widespread implementation of Medicaid managed care may have damaged the ability of the health care safety net to provide services to the uninsured. To address this concern, I combined data from the National Health Interview Survey and a county-level data base on Medicaid managed care plans from 1994-2001.
Using regression analyses, I investigated five access to care measures: delay in getting care due to cost, needing but not getting care due to cost, having a usual source of care, having a non-emergency usual source of care, and having any doctor visits in the past year. I compared managed care plans with mandatory versus voluntary enrollment, use of primary care case management and use of health maintenance organizations. Further, I assessed subgroups of the uninsured based on age, presence of chronic illness and health status.
None of the access to care measures indicated a consistent effect of any type of Medicaid managed care on the uninsured. Some statistically significant effects were seen in most subgroups of the uninsured; however, they showed improvement in some areas and worsening in other areas within each subgroup. Further, no consistent differences were found between the uninsured with fair or poor health and the uninsured with good, very good or excellent health. The lack of a systematic effect is reassuring about the integrity of the safety net, although this study is limited in that it only addresses perceptions of care.