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.

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.