Restricting Medicaid payments for transportation: Effects on inner-city patients' health care

Background: Prior approval programs have been used to control spiraling cos ts of Medicaid, but they are rarely formally assessed. We evaluated the eff ect of a change in Indiana Medicaid's policy (effective October 1, 1993) re quiring prior approval to pay transportation costs. Methods: We performed a historical cohort study comparing the health care utilization of Medicaid patients during the first 6 months of 1993 versus the first 6 months of 199 4. Subjects included all Medicaid patients who visited any inpatient or out patient site affiliated with an inner-city public hospital in the first 6 m onths of 1993 (N = 23,015) and 1994 (N = 23,707). Results: These Medicaid p atients made 82,961 visits in the first 6 months of 1993 and 79,809 visits in the first 6 months of 1994. Visits to hospital-based primary care clinic s declined 16% (P < 0.001), which was partially offset by a 7% increase in visits to neighborhood health centers (P less than or equal to 0.001). Emer gency and urgent visits fell by 8%; visits for medication refills fell by 1 8% (P < 0.001 for each). Hospitalizations increased slightly in 1994, with no change in the number of inpatient days. There was no change in inpatient or outpatient nontransportation charges. There were no systematic reductio ns in selected aspects of preventive care. However, there were fewer emerge ncy and urgent visits among patients with reactive airway disease. Conclusi ons: Requiring prior approval for transportation was associated with reduct ions in visits for primary care visits and refilling prescriptions without measurable shortterm effects on charges or selected clinical parameters. Ne ighborhood health centers partially ameliorated the decline in primary care visits.