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Managed Care

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Lack of insurance and living in an area with greater managed care activity reduce access to care

Individuals who do not have health insurance coverage for part of a year or an entire year and those living in areas with more managed care are more likely to have problems accessing care than others. In fact, greater managed care activity is associated with less favorable access to care, regardless of insurance status, notes David Litaker, M.D., Ph.D., of the University Hospital of Cleveland, and Randall D. Cebul, M.D., of Case Western Reserve University.

In a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00059), they surveyed Ohio households in 1998 to examine the association between managed care activity and individuals' access to care, medications, supplies, and/or medical equipment in the past year and differences in this relationship by insurance status.

Overall, 8 percent of the 15,613 adults surveyed said they had an access problem in the year prior to the survey. The most common problems reported were inability to obtain dental care (30 percent), medications or prescriptions (22 percent), or care by a physician (14 percent). More of those who were continuously uninsured had access problems (31 percent) than those who were intermittently (25 percent) or continuously insured (5 percent).

The proportion of residents with access problems also differed significantly across zip codes, with 7.7 percent in areas of low managed care penetration reporting problems with access to care, compared with 9.2 percent of those in areas of high managed care penetration. Individuals living in areas with more managed care had 28 percent higher odds of reporting problems obtaining care than those elsewhere. Difficulties meeting health care needs within each stratum of insurance status were increasingly common as the level of managed care activity increased.

See "Managed care penetration, insurance status, and access to health care," by Drs. Litaker and Cebul, in the September 2003 Medical Care 41(9), pp. 1086-1095.

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