Low-income individuals with private health insurance coverage have better access to medical care in urban and rural areas than Medicaid beneficiaries, a study in the Journal of Health Care for the Poor and Underserved found. However, the authors found that Medicaid beneficiaries' level of access to care is more consistent than low-income, privately insured people in urban and rural areas.
For the study, researchers analyzed data from the National Survey of America's Families, which over-sampled low-income families. NSAF data were used from 1997, 1999 and 2002.
The study found that Medicaid beneficiaries obtained similar levels of care in urban and rural areas except in regard to dental care, which was lacking in rural areas. Medicaid beneficiaries were more likely than low-income, privately insured individuals to visit an emergency department and less likely to have a dental visit, researchers found.
The study found greater care disparities between low-income, privately insured beneficiaries in rural areas and those in urban areas.
According to researchers, Medicaid beneficiaries' consistent level of access to care might reflect the uniform structure of the program, compared with private insurance plans for low-income adults. Such plans usually provide fewer benefits and have higher copayments and deductibles, the authors stated.
The authors call on policymakers to address "clear gaps" in Medicaid coverage -- particularly in access to dental care, a benefit that varies by state. In addition, the high use of EDs by Medicaid beneficiaries suggest barriers to care that might be avoided by better access to primary or specialist care, the study found (Long et al., Journal of Health Care for the Poor and Underserved, August 2006).
Adult Medi-Cal beneficiaries with disabilities would prefer higher out-of-pocket costs for higher-income beneficiaries and limits on how services are utilized than other changes to the program that could result in restrictions on services and access to providers, according to a study in the Journal of Health Care for the Poor and Underserved.
For the study, researchers tailored Choosing Healthplans All Together (CHAT) -- a computer simulation exercise where users prioritize health care services, copayments and restrictions with a limited amount of resources -- to relevant Medi-Cal issues. The authors then conducted 12 sessions with 131 adult Medi-Cal beneficiaries with disabilities in 12 California counties during April and May 2004.
The study found that the beneficiaries opposed reductions in provider reimbursements or other actions taken that might limit access to care. Beneficiaries also were against eliminating any benefit categories because of the potential scope of any benefit reduction.
Researchers said the findings of this study and use of the CHAT program might be useful to policymakers in Medicaid reform efforts. The authors noted that CHAT results should not be mistaken as "acceptance" of cuts, but as a way for beneficiaries to convey coverage priorities to policymakers.
According to the study, beneficiary preferences should be taken into account in establishing priorities under new Medicaid policies (Danis et al., Journal of Health Care for the Poor and Underserved, August 2006).