Access and Satisfaction with Care for Children with Special Health Care Needs in Medicaid Managed Care Plans

1
Access and Satisfaction with Care for Children
with Special Health Care Needs in Medicaid
Managed Care Plans

• Sue E. Kim, PhD
• Paul W. Newacheck, DrPH
• University of California, San Francisco

2
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.

3
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.

4
Objective

• To examine whether access and satisfaction
  differed for Medicaid enrolled CSHCN in managed
  care organizations versus those not in managed
  care.

5
Methods

• Design Cross-sectional study
• Subjects Children lt18 years old with special
  health care needs
• Dataset 2000 and 2001 Medical Expenditure Panel
  Survey (MEPS)

6
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.

7
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

8
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

9
Study Population

• Sample size808
• 13, 717 children lt18 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

10
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

11
Results

• Childs doctors explains things in a way parents
  can understand

Medicaid MCO (n429) Medicaid-other (n260)
Never 1.7 2.1
Sometimes 7.9 11.6
Usually 25.4 12.9
Always 65.1 73.4
P.03
12
Results

• Childs doctors spend enough time with child and
  parent

Medicaid MCO (n430) Medicaid-other (n261)
Never 3.6 3.5
Sometimes 11.6 10.5
Usually 29.3 19.7
Always 55.5 66.3
P.05
13
Results

• Satisfied with Usual Source of Health Care Staff

Medicaid MCO (n485) Medicaid-other (n278)
Very Satisfied 65.8 78.3
Somewhat Satisfied 28.8 18.1
Not too/Not at all Satisfied 3.6 5.4
P.05
14
Results

• Satisfied with Quality of Care

Medicaid MCO (n485) Medicaid-other (n278)
Very Satisfied 70.5 80.9
Somewhat Satisfied 23.9 15.9
Not too/Not at all Satisfied 5.6 3.2
P.05
15
Results

• Problems in getting referral to specialist

Medicaid MCO (n177) Medicaid-other (n120)
Problem 33.4 16.6
No Problem 66.6 83.4
Plt.01
16
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

17
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

18
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.

19
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.

20
Implications

• Important to consider whether lower satisfaction
  with providers in managed care plans and greater
  difficulty in accessing specialists are
  associated with lower quality of clinical care.