Coughlin Teresa A, Long Sharon K, Graves John A
Urban Institute, 2100 M St., N. W, Washington DC 20037, USA.
Inquiry. 2008;45(4):395-407. doi: 10.5034/inquiryjrnl_45.04.395.
States increasingly are shifting Medicaid beneficiaries with disabilities from the fee-for-service (FFS) delivery system to managed care in an effort to control program costs and address long-standing problems with access to care under the program. Using a county-based measure of managed care enrollment and pooled data from the 1997 to 2004 National Health Interview Surveys, we investigate whether Medicaid managed care (MMC), relative to FFS Medicaid, improves access to care. We find some evidence of improved access to care under MMC; however, the gains appear to be largely limited to beneficiaries in urban areas with fully capitated managed care. There is little evidence of improved access under primary care case management or, regardless of MMC type, in rural areas.
各州越来越多地将残疾医疗补助受益人从按服务收费（FFS）的医疗服务提供系统转移到管理式医疗，以控制项目成本，并解决该项目长期存在的医疗服务获取问题。利用基于县的管理式医疗参保情况指标以及1997年至2004年全国健康访谈调查的汇总数据，我们研究了相对于FFS医疗补助，医疗补助管理式医疗（MMC）是否能改善医疗服务的获取情况。我们发现了一些MMC改善医疗服务获取情况的证据；然而，这些改善似乎主要限于参加全额预付管理式医疗的城市地区受益人。几乎没有证据表明初级保健病例管理能改善医疗服务获取情况，而且无论MMC类型如何，农村地区也没有这种改善的迹象。
