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Health Care Costs and Financing

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Treating more Medicaid managed care patients in community health centers may reduce care for uninsured patients

Since they began in the 1960s, community health centers (CHCs) have served as a primary care safety net for medically vulnerable groups. However, the findings from a recent study sound a warning note that the ability of CHCs to provide health care for the uninsured might be compromised by managed care. The study, which was supported in part by the Agency for Healthcare Research and Quality (HS09831), found that CHCs involved in managed care served a significantly smaller proportion of uninsured patients (33 to 35 percent) than CHCs not involved in managed care (42 to 45 percent). What's more, as non-managed care centers became involved in managed care, the proportion of uninsured patients they treated declined. Even after controlling for CHC location and center-specific indicators, uninsured users declined by more than 5 percent of total users for every 10,000 managed care enrollees treated.

Greater financial pressures from managed care and other factors might force CHCs to use Federal grant funding to cover the full cost of their capitated Medicaid patients, thus reducing funds available to cover costs of care for the uninsured. Yet even with the uninsurance rate at more than 30 percent for centers involved in managed care, that rate is still double the national average (16 percent) and is far greater than the percentage of uninsured patients seen by other providers.

Managed care did positively affect other vulnerable populations served by CHCs. For example, managed care centers served a significantly greater proportion and number of Medicaid users than non-managed care centers. Nevertheless, given the relatively short history of managed care within CHCs, it is still premature to assess the impact of managed care on CHCs, cautions Leiyu Shi, Dr.P.H., M.B.A., of Johns Hopkins University. Dr. Shi and colleagues analyzed data from the Uniform Data Systems maintained by the Bureau of Primary Health Care, Health Resources and Services Administration, which provides a health center profile, user profile, staffing and use profile, and financing profile. For this study, the researchers used UDS data from 1990-1998, since CHCs became involved in managed care after 1990.

See "The impact of managed care on the mix of vulnerable populations served by community health centers," by Dr. Shi, Robert M. Politzer, Ph.D., Jerri Regan, R.N., M.S., M.P.A., and others, in the January 2001 Journal of Ambulatory Care Management 24, pp. 51-66.

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