Access and Satisfaction with Care for Children with Special Health Care Needs
in Medicaid Managed Care Plans
Sue E. Kim, PhDPaul W. Newacheck, DrPH
University of California, San Francisco
Background
• Children with Special Health Care Needs (CSHCN) are children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition.
• About 16% (11 million) of children are identified as having special health care needs.
Background
• Use more health care services than other children.
• Have higher health care expenditures.
• Few studies have examined access and satisfaction using a nationally representative sample.
Objective
• To examine whether access and satisfaction differed for Medicaid enrolled CSHCN in managed care organizations versus those not in managed care.
Methods
• Design: Cross-sectional study
• Subjects: Children <18 years old with special health care needs
• Dataset: 2000 and 2001 Medical Expenditure Panel Survey (MEPS)
Medicaid Managed Care Plans
• Identified plans from a list of state names or programs for Medicaid HMOs in the area.
• Medicaid Gatekeeper plans.
• Medicaid non-MCO– Covered by Medicaid, but the plan was not an
HMO or gatekeeper plan.
Primary Outcome Variables
• CAHPS and other Access Measures
– Access to care
– Problems receiving needed care
– Experiences during care
– Problems in getting a referral to a specialist
– Usual source of health care
Analysis
• Pearson chi-squared statistics to compare difference between CSHCN enrolled in Medicaid managed care plans and non- managed Medicaid plans.
– 2000 and 2001 MEPS data pooled– Corrected for complex survey design
Study Population
• Sample size=808
– 13, 717 children <18 years old
– 2,205 (16%) with special health care needs
– 808 (37%) in Medicaid• 511 (63%) Medicaid HMO/managed care
• 297 (37%) non-managed Medicaid plan
Results
• Access to Care: No significant difference
– Have usual source of health care
– Able to make routine appointment when needed
– Received illness or injury care when wanted
– Had no problem receiving necessary care
Results• Child’s doctors explains things in a way
parents can understand
Medicaid MCO(n=429)
Medicaid-other(n=260)
Never 1.7% 2.1%
Sometimes 7.9% 11.6%
Usually 25.4% 12.9%
Always 65.1% 73.4%
P=.03
Results• Child’s doctors spend enough time with
child and parent
Medicaid MCO(n=430)
Medicaid-other(n=261)
Never 3.6% 3.5%
Sometimes 11.6% 10.5%
Usually 29.3% 19.7%
Always 55.5% 66.3%
P=.05
Results
• Satisfied with Usual Source of Health Care Staff
Medicaid MCO(n=485)
Medicaid-other(n=278)
Very Satisfied 65.8% 78.3%
Somewhat Satisfied
28.8% 18.1%
Not too/Not at all Satisfied
3.6% 5.4%
P=.05
Results
• Satisfied with Quality of Care
Medicaid MCO(n=485)
Medicaid-other(n=278)
Very Satisfied 70.5% 80.9%
Somewhat Satisfied
23.9% 15.9%
Not too/Not at all Satisfied
5.6% 3.2%
P=.05
Results
• Problems in getting referral to specialist
Medicaid MCO(n=177)
Medicaid-other(n=120)
Problem 33.4% 16.6%
No Problem 66.6% 83.4%
P<.01
Conclusions
• No significant difference in health care access for CSHCN enrolled in managed care and non-managed Medicaid plans.
• Majority of respondents
– had usual source of health care
– able to receive routine care
– had no problem receiving necessary care
Conclusions
• CSHCN enrolled in managed care Medicaid plan showed lower satisfaction with their physicians.
– Spending enough time with child and parent
– Satisfaction with usual source of care staff
– Satisfaction with quality of care
Conclusions
• Referral to Specialist
– Medicaid managed care plan enrollees are two times more likely to have problem getting referral to specialist compared to non-managed care plans.
Limitations
• MEPS estimates of the number of persons in HMOs are higher than industry figures.
• Managed care questions asked about the last plan held by respondent.
• Preliminary results and only descriptive.