EVALUATION OF MEDICAID MANAGED CARE - SATISFACTION, ACCESS, AND USE

Objective.-To evaluate the effects of managed care on Medicaid benefic iaries' satisfaction with, access to, and use of medical care during e arly implementation of an enrollment initiative. Design.-Cross-section al survey of a random sample of Medicaid beneficiaries in 5 managed ca re plans and in the conventional Medicaid program. Setting.-New York, NY. Participants.-Adults aged 18 to 64 years who received Medicaid ins urance benefits through Aid to Families With Dependent Children or Sta te Home Relief and had been enrolled in a managed care plan or receivi ng benefits under conventional Medicaid for at least 6 months. Of the 2500 enrollees in managed care plans and the 600 other beneficiaries i n conventional Medicaid whom we surveyed, 1038 enrollees and 410 nonen rollees responded. Outcome Measures.-Beneficiaries' ratings of overall satisfaction and 13 dimensions of satisfaction related to access, int erpersonal and technical quality, and cost; reports of access, includi ng regular source (location) of care, waiting time for appointment, wa iting time in office, and ability to obtain care; and reports of use, including inpatient, emergency department, and ambulatory visits. Resu lts.-Compared with beneficiaries in conventional Medicaid, managed car e enrollees in general gave higher ratings of satisfaction. The result s were not consistent, however, between the proportion who were extrem ely satisfied and the proportion who were extremely dissatisfied. Mana ged care enrollees had significantly greater odds of being extremely s atisfied (excellent and very good ratings), but fewer differences were statistically significant for levels of extreme dissatisfaction (fair and poor ratings). With regard to access, managed care enrollees had significantly greater odds of having a usual source of care (odds rati o [OR], 2.33) and seeing the same clinician there (OR, 2.72) and had s ignificantly shorter appointment and office waiting times. Managed car e and conventional Medicaid beneficiaries reported no significant diff erences in obtaining or delays in getting needed care and in inpatient or emergency department use. Conclusions.-Medicaid managed care enrol lees in New York City reported better access to care and higher levels of satisfaction compared with conventional Medicaid beneficiaries. Di fferences between these findings and those for privately insured popul ations highlight the pitfalls of generalizing from other groups to Med icaid for policy purposes. Given growing reliance on consumer satisfac tion surveys for clinical and public policy, future research should fo cus on factors that explain extreme satisfaction vs extreme dissatisfa ction. New York State's initiative, which has been associated with car eful state and local monitoring, merits continuing evaluation as manag ed care enrollment grows and may become mandatory.