Dissertation
The effect of medicaid HMOs on health access, utilization, and health outcomes for children
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2022
DOI: 10.17077/etd.006410
Abstract
Mandatory HMO is the dominant service delivery model for children with Medicaid, with over 80% of children enrolled in Medicaid HMO programs to receive their Medicaid benefits. However, the literature on the effects of mandatory Medicaid HMO enrollment on child health outcomes is often limited in the geographic representation of the study data or the number of years studied and includes mixed and contradictory results. The dissertation adds novel insights to understanding the effects of mandatory Medicaid HMO enrollment on children.
The dissertation exploits the significant variation in the implementation of Medicaid managed care programs within and across states to examine the effect of mandatory Medicaid HMO enrollment on access, utilization, and health outcomes for children using regression analyses and national-level data from the Medical Expenditure Panel Surveys (2000 to 2018). In addition, it examines for potential heterogeneity in the effects of mandatory HMO enrollment across individual characteristics, including age, race and ethnicity, and the presence or absence of special care needs. Lastly, it evaluates the effects of Medicaid HMO on access, utilization, and health status outcomes for Medicaid children with asthma to further investigate effective access to care.
Overall, the results show that mandatory HMO enrollment was associated with a 1.8 percentage point reduction in the likelihood of having a usual source of care and a 4.2 percentage point increase in the likelihood of delayed access to care for acute illness. In terms of utilization, the results suggest that overall, mandatory HMO enrollment was associated with a 2.2 percentage point reduction in the likelihood of having any outpatient physician visits. However, the results on health status measures were mixed, making it difficult to discern a consistent direction of the effects of mandatory HMO enrollment on child health status. There was also evidence of heterogeneity in the effects of mandatory HMO enrollment across age, race and ethnicity, and the presence or absence of special care needs. Black non-Hispanic children and older children were more likely to experience unmet needs for care during acute illness; Hispanic children, children ages 6 to 11 years, and children without special health care needs were less likely to have an outpatient physician visit; and children with special health care needs were more likely to have the unmet need for specialist care. However, there was no evidence that mandatory HMO enrollment had any effects on access, utilization, and health status among Medicaid children with asthma compared to other MMC types and Medicaid FFS.
These findings suggest a decline in certain access and utilization measures but little evidence of effects on health needs and health status with mandatory Medicaid HMO enrollment. HMO network adequacy is fundamental to accessing needed services for children in Medicaid HMOs. However, federal regulation of Medicaid HMO network adequacy is limited, and states vary significantly in their standards for and regulation of Medicaid HMO network adequacy. Therefore, the findings of this study provide timely information highlighting the need for policymakers to consider implementing standardized measures for network adequacy and ensuring proper federal and state oversight to monitor plan compliance with these requirements.
Details
- Title: Subtitle
- The effect of medicaid HMOs on health access, utilization, and health outcomes for children
- Creators
- Patience G. Ugwi
- Contributors
- George Wehby (Advisor)Keith Mueller (Committee Member)Dan Shane (Committee Member)Xi Zhu (Committee Member)Kanika Arora (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Health Services and Policy
- Date degree season
- Spring 2022
- DOI
- 10.17077/etd.006410
- Publisher
- University of Iowa
- Number of pages
- xiv, 123 pages
- Copyright
- Copyright 2022 Patience G. Ugwi
- Language
- English
- Description illustrations
- Tables, graphs
- Description bibliographic
- Includes bibliographical references (pages 116-123).
- Public Abstract (ETD)
Mandatory HMO is the dominant service delivery model for children with Medicaid, with over 80% of children enrolled in Medicaid HMO programs to receive their Medicaid benefits. However, the literature on the effects of mandatory Medicaid HMO enrollment on child health outcomes is often limited in the geographic representation of the study data or the number of years studied and includes mixed and contradictory results. The dissertation adds novel insights to understanding the effects of mandatory Medicaid HMO enrollment on children.
The dissertation exploits the significant variation in the implementation of Medicaid managed care programs within and across states to examine the effect of mandatory Medicaid HMO enrollment on access, utilization, and health outcomes for children.
Overall, there is evidence of a decline in certain access and utilization measures but little evidence of effects on health needs and health status with mandatory Medicaid HMO enrollment among children in Medicaid. However, for children in Medicaid who have asthma, there is no evidence that mandatory HMO enrollment had any effects on access, utilization, and health status compared to other MMC types and Medicaid FFS.
These findings highlight the need for policies that ensure Medicaid HMO network adequacy and provide proper federal and state oversight to monitor plan compliance with network adequacy standards, as Medicaid HMO network adequacy is fundamental to accessing needed services for children in Medicaid.
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984271452402771
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