Can I Use Ohp In Another State

• Journal List
• Health Serv Res
• v.37(1); 2002 Feb
• PMC1430346

Health Serv Res. 2002 Feb; 37(1): 19–39.

Impact of the Oregon Health Program on Access and Satisfaction of Adults with Depression-income

Abstract

Objective

To evaluate the furnishings of the Oregon Health Plan (OHP) on beneficiary admission and satisfaction.

Information Sources

Telephone survey of nondisabled adults in 1998.

Study Pattern

Two groups of adults were surveyed: OHP enrollees and Food Postage recipients not enrolled in OHP. The Food Postage stamp sample included both privately insured and uninsured recipients. This allowed united states of america to disentangle the insurance furnishings of OHP from other furnishings such equally its reliance on managed care and the priority listing. OHP and Food Postage stamp adults were compared forth the following measures: usual source of care, utilization of health care services, unmet demand, and satisfaction with care.

Data Collection

The survey was conducted by phone, using estimator-assisted phone interviewing techniques.

Principal Findings

Much of OHP'southward impact has been realized by its extension of health insurance coverage to Oregon's low-income residents. The availability of health insurance significantly increased the utilization of many health care services and reduced unmet need for intendance. OHP was associated within a higher percentage of enrollees having a usual source of care and college rates of Pap test screening among women compared with Food Stamp recipients. OHP enrollees also reported significantly college use of dental care and prescription drugs; apply we attribute to the expanded benefit bundle under the priority listing. At the same time, OHP enrollees reported a greater unmet need for prescription drugs. Drug treatment for beneath-the-line conditions was one reason for this unmet need, simply often the specific drug simply was not in the program's formulary. OHP enrollees were as satisfied with their health care as those Nutrient Stamp recipients with private health insurance.

Conclusions

Despite the negative publicity prior to its implementation, there is no evidence that "rationing" under OHP'southward priority list has substantially restricted access to needed services. OHP adults appear to enjoy access equal to or better than that of low-income persons with private health insurance and have far greater access than the uninsured.

Keywords: Medicaid managed intendance, access to care, insurance expansion

The Oregon Health Plan (OHP) is Oregon'south innovative Medicaid 1115 waiver programme. Information technology garnered national attention for its utilize of a prioritized list of services to ascertain the program's benefit package. The priority list consists of paired medical conditions and treatments that are ranked hierarchically from the well-nigh to the least medically necessary. Covered services are those at or above a cut-off line that is established based on the state's budgetary resources. The utilise of a priority listing was widely condemned past many advocates, physicians, and politicians from both parties (Bodenheimer 1997; Dark-brown 1991; Fox and Leichter 1993; Jacobs, Marmor, and Oberlander 1999; Steinbrook and Lo 1992). Critics worried whether Medicaid beneficiaries in Oregon would receive the intendance they needed or whether they would be denied medically necessary services because they were "below the line." The utilize of a priority listing was so controversial that information technology delayed federal approving of the land'southward waiver for 2 years.

Although the priority listing received the about media attention, in that location are two other equally important components of OHP. (For a more detailed clarification of the OHP, the reader is referred to Bodenheimer [1997], Gold [1997], and Mittler, Gold, and Lyons [1999]). Kickoff, OHP expanded Medicaid eligibility to embrace all uninsured residents up to 100 percent of the Federal Poverty Level (FPL). This has added an average of 100,000 persons to the state's Medicaid rolls or an increase of approximately 25 percent. Second, about all nondisabled OHP beneficiaries have been enrolled in capitated managed care plans. Each ane of these three OHP components may take an effect on access to intendance, and any evaluation of OHP must ideally try to disentangle the differential effects.

How might these three unlike components of OHP affect admission? Eligibility expansion is expected to meliorate access, as previously uninsured individuals presumably faced difficulties obtaining intendance. Previous research has clearly shown that extending health insurance to the uninsured increases utilization of doctor and other services (Bograd, Ritzwoller, Calonge, et al. 1997; Freeman and Corey 1993; Hahn 1994; Long and Marquis 1998; Martin, Diehr, Cheadle, et al. 1997; Schoen, Lyons, Rowland, et al. 1997). The net effects of managed intendance and the priority list are less clear. Oregon Health Plan beneficiaries enrolled in managed care plans may encounter barriers to services requiring prior say-so past their principal care physician, such equally specialist referrals. Several studies of Medicaid managed care programs have found evidence of greater difficulty accessing services, including specialist visits, compared with fee for service (Freund and Lewit 1993; Lillie-Blanton and Lyons 1998; Rowland et al. 1995). On the other hand, enrollment in a plan and assignment to a primary intendance provider may assure access to a usual source of intendance (Coughlin and Long 1999; Sisk, Gorman, Reisinger, et al. 1996). Similarly, although implementation of the priority list may restrict admission to those services that are below the line, the listing itself is based on a far more expansive list of services than had been covered under Oregon's traditional Medicaid programme (for example, dental intendance for adults).

In this article, we evaluate OHP's touch on on access for traditional (Aid to Families with Dependent Children [AFDC], now Temporary Assistance to Needy Families) Medicaid beneficiaries as well as expansion beneficiaries. These eligibility groups were among the start to be enrolled in OHP in February 1994. Thus, by the time of our survey (1998), OHP was a mature wellness plan, serving these eligibility groups for 4 years. This commodity is express to the experience of adults. A companion study will examine the OHP experience of children.

CONCEPTUAL FRAMEWORK

Our behavioral model of admission to health care services is based on that developed past the Institute of Medicine (Millman 1993) and was extended by Golden (1998). The Institute of Medicine model describes three types of barriers that may affect utilization: structural, financial, and personal. Gold argues that in today'south complex health care arrangement, structural and fiscal barriers cannot be so easily distinguished. Nether managed care, financing and commitment of care are ofttimes inextricably bound together. Enrollment in OHP is the principal structural variable in our model; information technology both defines the fashion in which care is financed (capitated HMO) and the benefits provided (the priority list). Other structural variables include geographic residence to capture the relative availability of providers. Financial variables include health insurance and employment. Personal variables expected to influence admission include age, gender, race/ethnicity, education, and health status.

METHODS

Evaluation Design

As Gold (1999a) has noted, evaluation of Medicaid managed care impacts is fraught with pitfalls, particularly the frequent absence of baseline data and the difficulty in identifying an appropriate comparison group. Our study is no different in this respect. The absence of pre-OHP information required the use of a cantankerous-sectional design. We compared OHP adults with a group of low-income adults, non enrolled in OHP, drawn from state Food Stamp recipients. The Food Stamp eligibility ceiling is 130 percent of FPL; thus, our comparison group presumably has boilerplate incomes somewhat higher than those of OHP beneficiaries (101 to 130 percent of FPL). Considering some Food Stamp recipients may take private health insurance, whereas others remain uninsured, this comparing grouping has the boosted advantage of allowing us to disentangle the "insurance" result of OHP from other characteristics of OHP (such as mandatory managed care and the priority list).

Sample Pick

Samples of adults aged 19 to 64 were selected from both the OHP and Food Stamp populations using state 1998 eligibility files for both programs. Oregon Health Programme beneficiaries included those eligible under both the AFDC and the expansion programs, in proportion to their prevalence in the OHP population. The Food Stamp sample was selected so that historic period, gender, and geographic distribution would be every bit similar as possible to that of the OHP sample. The Nutrient Stamp participant file was matched with the OHP eligibility file to exclude persons enrolled in OHP during the previous 12 months.

There were considerable difficulties and 12 months of negotiations before gaining the country's permission to employ the Nutrient Stamp eligibility file for sampling purposes. Over the course of this twelvemonth, the Nutrient Stamps function in Oregon switched from the traditional method of mailing food stamps to recipients each month to an automated debit carte arrangement that kept runway of recipients' "accounts." Nether the debit card system, a recipient no longer needed to maintain electric current address information with the state in order to receive Nutrient Stamp benefits. This made it much more difficult to locate the Food Stamp sample, as is seen afterward in this article.

Data Collection

The survey was conducted by phone, using figurer-assisted telephone interviewing techniques. Tracing procedures were used for cases that could non be contacted given the information on the eligibility files. Tracing procedures included calls to directory help and to family members and electronic searches of commercial databases. A full of one,205 OHP beneficiaries and 316 Food Stamp recipients responded to the survey, with response rates of 70 and 33 percent, respectively. Among the Nutrient Postage stamp recipients, merely over one one-half (160) had individual health insurance, nearly always through an employer. The remaining 156 recipients were uninsured, and most of them reported they only could non afford wellness insurance. Despite extensive tracing, many Food Postage stamp sample members could not be located. Low-income populations tend to be highly mobile and often practice not leave forwarding address information. Some sampled members did not have valid social security numbers, whereas others did non have credit histories, and both of these factors complicated the tracing effort. When located, however, almost all eligible respondents participated in the survey. Only four.seven per centum of sampled OHP beneficiaries and 6.7 percent of sampled Food Postage stamp recipients refused to participate.

Nonresponse and Selection Bias

The response rate for the OHP sample is equally high or higher than those accomplished in other published surveys of Medicaid populations (Brown, Nederend, Hays, et al. 1999; Coughlin and Long 1999; Rosenbach, Irvin, and Coulam 1999; Schoen, Lyons, Rowland, et al. 1997; Sisk, Gorman, Reisinger, et al. 1996; Szilagyi, Zwanziger, Rodewald, et al. 2000). In contrast, the response rate for the Food Stamp sample is only half equally high as that for the OHP sample and two thirds of the 50 percent response rate achieved past many of these other studies. Considering data collection and tracing procedures for the OHP and Nutrient Stamp samples were identical, information technology would seem that the dramatic difference in their response rates can be attributed to the poorer quality of the addresses in the Food Postage eligibility file. This suggests that nonrespondent Food Postage recipients were more probable to have moved one or more times compared with those located past survey interviewers.

Some sociodemographic information was available from state Food Postage files to evaluate potential nonresponse bias. We found no differences between respondents and nonrespondents with regard to age, gender, or geographic residence. However, nonrespondents were significantly more likely to be Hispanic. Only English-speaking interviewers were available for the survey, which most certainly made information technology even more difficult to locate and interview Hispanic sample members.

In addition to nonresponse bias, selection bias may be another study limitation. If OHP and Food Stamp respondents differ in ways that are correlated with their employ of wellness intendance services, and so our estimated OHP effect may be biased. The implications of both pick and nonresponse bias for our written report are discussed at the end of this article.

Statistical Tests

Chi-square tests were used to determine the statistical significance of all categorical variables and t tests for continuous variables. Logistic regression was used to evaluate OHP impacts, while adjusting for confounding variables like wellness condition. All observations were weighted to adapt for the probability of selection, including nonresponse. SUDAAN software was used for both descriptive and multivariable analyses to adjust variances for the effect of diff weights and unequal probabilities of option beyond groups.

RESULTS

Descriptive Findings

Sociodemographic Characteristics and Health Status

Tabular array 1 compares sociodemographic characteristics and health status of OHP beneficiaries with insured and uninsured Nutrient Stamp recipients. Oregon Health Plan beneficiaries were significantly more likely to be female and significantly less likely to be married compared with Food Postage recipients. This is non surprising, given that 1 third of the OHP sample were eligible through the AFDC program (which is largely composed of single mothers). There were no differences in the average historic period of OHP and comparison group members.

Table 1

Sociodemographic Characteristics and Wellness Status

A loftier proportion of both OHP and comparing group adults reported that they were "currently employed in a job for pay," although the comparison grouping was significantly more likely to be employed (62 to seventy percent vs. 45 percent). Reflecting the population of the country as a whole, the vast majority of both OHP beneficiaries and Food Stamp recipients reported they were White and non-Hispanic. In that location was considerable divergence in educational levels, notwithstanding, with the insured Food Stamp sample significantly better educated compared with OHP adults and the uninsured sample somewhat less educated.

Finally, in that location was a marked divergence in geographic location, with uninsured Food Stamp recipients more likely to be residing in rural parts of the state. This is consistent with land surveys that take documented higher rates of the uninsured in rural areas (Office for Oregon Health Programme Policy and Inquiry 1999).

Oregon Wellness Plan beneficiaries were in significantly poorer wellness compared with Food Stamp recipients. They had lower SF-12 scores for physical wellness than both insured and uninsured Food Postage recipients and lower mental health scores than the insured recipients. (Lower scores on the SF-12 indicate poorer health.) Similarly, OHP members were approximately iii times more than probable than those in the comparison groups to report that a disability or health problem kept them from working at a job.

Usual Source of Care and Utilization

OHP beneficiaries were significantly more likely than comparison group members to study that they had a usual source of care, that is, "a identify they ordinarily get to when they are sick or need advice nigh their health" (Tabular array two). Among those with a usual source of care, OHP beneficiaries also were significantly more than probable to written report that they had a usual wellness intendance provider, that is, "a particular doctor or other medical person that they usually see at this place." These higher rates for OHP versus insured Food Stamp recipients may reflect their college rate of enrollment in a managed care plan; virtually all of the OHP sample were enrolled in a managed-care program (97 pct) compared with approximately 1 one-half (54 percent) of the insured comparison group (data non shown). Managed-care enrollment for the insured Food Stamp sample was based on cocky-report, unlike for OHP where we could independently verify enrollment. Unfortunately, no other health insurance information was collected for insured Nutrient Postage recipients, for instance, type of programme and benefits.

Tabular array 2

Utilization of Health Intendance Services

Equally a rule, utilization of health intendance services is significantly college for OHP beneficiaries than for both insured and uninsured comparison group members. The majority of OHP beneficiaries (71 pct) had seen a doctor in the past iii months, compared with 58 percent of insured Food Postage recipients and only 31 percent of uninsured recipients. Healthy, nonpregnant adults are unlikely to visit the md more than once a year, yet, and the percent with a physician visit in the by 12 months may be a more reasonable measure for comparing. Although the utilization gap is definitely narrowed, OHP beneficiaries were notwithstanding significantly more than likely to have seen a physician at least once during the past twelvemonth, peculiarly compared with the uninsured.

Compared with uninsured Food Stamp recipients, OHP members were significantly more than likely to take received a routine physical test during the past 12 months. Oregon Health Program members were also significantly more likely to have had their blood pressure checked than those in either comparison group.

Two questions were asked of women respondents only: (1) whether they had had a Pap smear in the past 12 months and (2) for those 40 years or older merely whether they had a mammogram in the by year. Women enrolled in OHP were more likely to take had these screening tests than comparing group women, but the differences were not statistically significant (except for Pap tests, where the OHP-uninsured deviation was pregnant at the 0.ten level).

Oregon Wellness Program adults were far more likely to accept visited a specialist in the by year, compared with Nutrient Stamp recipients, and were twice as likely to have been hospitalized. Specialist visits included visits to OB-GYNs and hospitalizations included maternity admissions; thus, these differences might be explained by the preponderance of females in the OHP population.

Unlike many private health insurance plans, the OHP covers many dental services for adults. This may explain the significantly higher number of OHP adults who have seen the dentist in the past year. The difference is particularly marked for the uninsured who are simply half as likely to have visited the dentist compared with OHP members (25 vs. 57 percent).

Oregon Wellness Program beneficiaries were significantly more likely to have received a prescription for medicine over the by year compared with Food Postage stamp recipients. The differences in use are quite high; 86 per centum of OHP adults got a prescription compared with 62 percent of insured Nutrient Postage adults and only 46 percentage of those without insurance. Many factors could contribute to these differences, including medical need, admission to a physician to prescribe the drug in the first place, cost of the drug, and insurance coverage. (OHP covers most prescription drugs, but not all commercial policies include drug coverage). We tin can control for some, only non all, of these other factors in our regression analyses. Finally, OHP adults were likewise more than likely to accept received mental wellness intendance or drug or alcohol handling compared with Food Stamp recipients, although the departure was statistically significant only with the insured comparison group. We know that OHP beneficiaries are in poorer mental wellness (based on their SF-12 scores) than insured Food Postage recipients, and this may explain the utilization difference.

Unmet Demand

Although OHP beneficiaries study receiving more wellness care services than comparison group members, they may still not receive as many every bit they demand or they may run into difficulties trying to obtain the services they exercise receive. Every bit shown in Table 3, well-nigh three quarters of both OHP and insured Food Stamp adults reported it was somewhat or very like shooting fish in a barrel to get the care they needed. In contrast, a significantly smaller number of uninsured adults (33 percentage) establish intendance was easy to get. Note, however, the substantial number of uninsured Food Stamp recipients reporting they did not need care over the by year: 31 vs. 12 pct and 19 percentage for OHP and insured Food Stamp adults, respectively.

Table 3

Unmet Demand for Health Care

Approximately one 8th of OHP beneficiaries (12.8 percent) reported they had needed to see a specialist during the past 12 months merely were not able to exercise then. This is significantly more insured Food Postage stamp recipients (vii.6 percent) but significantly fewer than uninsured Food Postage recipients (29.i pct). These uninsured adults overwhelmingly reported it "cost likewise much" every bit the reason they were unable to receive specialist care. In dissimilarity, only i quarter of OHP adults non receiving specialist care cited costs every bit the reason. The most frequent reason given (40 percent of cases) was the plan or primary care provider would not approve the intendance.

OHP adults were significantly less probable to report an unmet need for dental intendance than either of the two comparison groups. The vast bulk of both insured and uninsured Food Stamp recipients needing but not receiving dental care cited costs equally the reason. OHP adults who did not receive needed intendance despite being covered reported that either they could non find whatever dentists willing to have OHP patients or they were non able to get an appointment within a reasonable amount of fourth dimension. (Historically, in that location has been a shortage of Oregon dentists willing to treat Medicaid patients, a trouble that continues to exist nether OHP).

Approximately one 6th of OHP beneficiaries (17 percentage) said they were non able to obtain prescription medicine they needed, a significantly higher number than the insured comparing group (half dozen percent) but a significantly lower number than the uninsured grouping (26 percent). These uninsured adults cited costs as the reason for not getting the medicine. Amongst those OHP enrollees with an unmet need for prescription medicine, near two thirds (61 percent) said they did not get the medicine considering OHP would not pay for it. The 2d most frequent reason (20 percent) was their master care doc would non approve the prescription.

Relatively few respondents reported they needed merely did not receive mental health or drug or booze treatment. However, OHP beneficiaries were significantly more than probable to report such an unmet need, compared with insured Food Stamp recipients. These OHP respondents cited a wide variety of reasons, including lack of OHP approval, lack of physician referral, facility waiting lists, etc. There was no difference in unmet demand for mental health or substance abuse handling betwixt OHP and uninsured comparison group members.

Of grade, one reason OHP beneficiaries may not receive a needed service may exist because the service was "below the line" of the priority listing. As part of a dissever serial of questions, OHP beneficiaries were asked whether OHP had refused to pay for care their doc said they needed. I quarter (25.two percent) reported OHP had denied payment in the past year. Prescription drugs were by far the most common uncovered service, either because the drug was "below the line" (typically allergy drugs) or considering the drug was not in the plan'south formulary (see Mitchell and Bentley 2000, for a description of the methodology used to place below-the-line services.) Altogether, ten percent of the OHP sample reported OHP would not pay for care their doctor said they needed considering the treatment fell below the line. In addition to allergy drugs, other frequently mentioned beneath-the-line services included TMJ splints and treatment of back issues, such as physical therapy and chiropractic care.

Satisfaction with Intendance

Oregon Health Plan beneficiaries were by and large far more satisfied than Food Stamp recipients with both the quality of intendance they received and the depth of their insurance coverage. As shown in Table 4, OHP members were significantly more than probable to charge per unit their ability to see "the doctor or other medical person that [they] want to see" as very good or first-class compared with those in either comparison group. OHP beneficiaries were also significantly more satisfied with their "power to see a specialist when needed" than the uninsured and were as satisfied every bit those with private health insurance.

Table 4

Satisfaction with Intendance^a

Oregon Health Plan beneficiaries clearly perceived their insurance coverage for both health and illness care equally existence superior, with near two thirds rating it as very good or fantabulous. In dissimilarity, significantly fewer Food Stamp recipients rated their coverage this highly; only one third reported their coverage for "preventive intendance and routine visits," and 45 percent reported their coverage for "handling when sick" every bit very expert or excellent.

Finally, the majority of OHP beneficiaries stated that they were very satisfied with the overall quality of care they received, significantly more than those in the two comparison groups. Not surprisingly, the uninsured were specially dissatisfied.

Regression Analyses

Empirical Specification and Estimation

The descriptive results shown earlier demonstrated marked differences in utilization, with OHP beneficiaries consistently using more health care services than uninsured Food Stamp recipients and often more those with private wellness insurance as well. However, OHP adults were significantly more likely to exist female person and in poorer health compared with the two comparison groups, both factors that could explain their college employ rates. In society to test the impact of OHP on access and utilization, we used regression analysis to hold these and other covariates abiding.

2 variables were used to capture the impact of OHP: (1) a wellness insurance dummy prepare equal to ane for both OHP members and Food Stamp recipients with health insurance and (ii) an OHP dummy variable set equal to 1 for OHP beneficiaries merely. The wellness insurance dummy variable captures the effect of being insured on admission and apply. The OHP variable captures aspects of OHP in a higher place and across the plan as a health insurance plan per se. These include, for example, OHP's benefit package (divers by the priority list) and its greater reliance on managed care. Ideally, we would accept included a carve up variable to capture managed intendance. The very high managed care enrollment among OHP beneficiaries (97 percent) did not allow united states of america to split up out managed intendance from other OHP effects. Covariates included age, gender, race/ethnicity, health status, education, employment, marital status, and geographic residence.

Results

Table five displays odds ratios for all of the equations. The availability of health insurance has a powerful event on the utilization of most medical care services. OHP beneficiaries and Food Stamp recipients with wellness insurance were both significantly more likely than the uninsured to have a usual source of care, take seen a dr., received a routine test and blood pressure level bank check, visited a specialist, seen a dentist, and received prescription medicine.

Table 5

Logistic Regression Results for Wellness Care Utilization and Unmet Demand

The absence of an insurance effect on ER apply and hospital admission is not surprising. Persons with emergencies and with conditions serious enough to warrant hospitalization announced to go care, regardless of insurance status. Hospitals may also be less apt to plough people away because of liability concerns. The lack of an insurance effect on the remaining utilization measures (Pap test, mammography, and mental health/substance abuse treatment) on the other hand is surprising.

The OHP dummy variable is positive and significant in 4 of the 12 utilization equations. The odds of receiving Pap test screening in the past year was significantly college amongst women enrolled in OHP. Oregon Wellness Programme beneficiaries were also significantly more likely to have made a visit to a specialist (admitting significant simply at the 10 percent level), higher up and across the increased odds associated with health insurance per se. Enrollment in OHP besides raises the odds of a dental visit and receiving prescription drugs, again above and beyond the increased odds associated with having health insurance.

Although the OHP variable is insignificant in the remaining 8 regressions, it is important to go on in listen that OHP enrollment does raise the odds of making a physician visit and receiving a routine exam and blood pressure check relative to being uninsured. This upshot is being captured by the health insurance variable.

Table 5 also presents odds ratios for the iv unmet need equations. Insured respondents (whether insured past OHP or by individual health insurance) were significantly less likely to report an unmet need for a specialist visit, prescription medicine, or mental health/substance corruption handling compared with the uninsured. The access gap is considerable; adults with wellness insurance were only one 5th as likely every bit the uninsured to report that they needed simply did not get a visit to a specialist or a prescription drug. Although the odds ratio associated with health insurance was not significant, unmet need for dental care was significantly lower for OHP enrollees, yet.

Although the availability of health insurance reduced the odds of unmet demand for prescription medicine among all insured respondents, there was a large off-setting effect for OHP beneficiaries. Compared with both insured and uninsured Food Postage recipients, OHP enrollees were significantly more likely to study they needed a prescription drug but did not get information technology. We believe that this is due to two factors: (1) the priority list, which does not cover prescription drugs for certain atmospheric condition, such equally allergies, and (2) the greater managed care enrollment of OHP beneficiaries, which makes them more subject to formularies.

CONCLUSIONS AND POLICY IMPLICATIONS

Summary of Results

In that location are three principal components of the OHP that may affect access to intendance: (ane) eligibility expansion, (2) mandated managed intendance enrollment, and (three) the priority list. We summarize our primary findings around each of these components.

Eligibility Expansion

Much of OHP's impact has been realized by the simple extension of health insurance coverage to Oregon's depression-income residents. The availability of health insurance coverage significantly increased utilization of many health care services. Oregon Health Plan beneficiaries and Nutrient Stamp recipients with insurance were significantly more likely than the uninsured to have a usual source of care, meet a medico, receive routine exams, see a dentist, and receive prescription medicine. The size of this bear upon was often considerable; health insurance, whether OHP or private, raised the odds of a physician's visit more than threefold.

Even though OHP and privately insured respondents may receive more health intendance services than the uninsured, they yet may non receive as many as they actually need. Measuring "unmet demand" for intendance may provide a more rigorous test of access under the OHP. Once more, health insurance availability played an important role in reducing unmet demand for services. Insured adults (whether insured past OHP or by private health insurance) were less likely to written report they had needed simply not received a visit to a specialist or dental care compared with the uninsured.

Managed Intendance

Like many land Medicaid programs, Oregon has called to mandate managed care enrollment for its AFDC and expansion beneficiaries. As noted earlier, research to date comparing Medicaid managed care versus fee for service has been ambiguous, with some studies finding access to some services restricted under managed care, such as specialists, whereas others show improved access to a usual source of intendance. Although nosotros could not explicitly examination for managed-care effects (as virtually all OHP beneficiaries were enrolled in a managed care plan), we did attempt to capture the bear on of OHP above and beyond the program's impact equally a health insurance plan per se.

Oregon Health Plan beneficiaries were twice as probable to have a usual source of intendance, presumably considering enrollment in a managed care programme ensures a primary care provider is designated for each enrollee. Women enrolled in OHP too were twice as likely as other women to receive a Pap test, a finding that can perhaps be attributed to the preventive care orientation of managed care. However, OHP enrollment had no bear upon on the odds that a woman would receive mammography screening. Although the small number of women anile 40 years or older in our sample may be partly responsible for this finding, information technology bears further investigation.

There was no evidence of barriers to access to specialist services under OHP. Oregon Wellness Plan enrollment really increased the odds of visiting a specialist over the past year (albeit only at the ten percent level) and had no effect on unmet need for specialist care. Maybe most telling is the fact that the bulk of OHP beneficiaries rated their ability to see a specialist when needed as expert or fantabulous, levels equivalent to those of the privately insured.

Priority List

The use of a priority list to define the Medicaid packet is the single most distinctive aspect of the OHP. We attempted to measure its impact in two means: with our OHP dummy variable (which also captures managed care effects) and with a specific question on services denied by OHP. Oregon Health Program beneficiaries were significantly more than likely to have seen a dentist and to accept received prescription medicine over the by twelvemonth compared with Food Stamp recipients. Nosotros attribute this to the inclusion of adult dental services and prescription drugs in the OHP benefit package, benefits often excluded from private health insurance plans. At the same time, adults enrolled in OHP were twice equally probable to report they had needed prescription medicine over the past year but had not been able to receive it. When asked directly if OHP had ever refused to pay for a treatment they and their dr. thought they needed, prescription medicine was the single most ofttimes mentioned treatment that OHP would not pay for, sometimes considering the drug handling was beneath the line and hence non covered, but more oft because a specific brand-name drug was not authorized by the respondent'south managed-intendance programme or included in the plan'south formulary.

Study Limitations

The lack of baseline measures of access and potential pick bias are definite limitations of this evaluation. If OHP and Nutrient Stamp respondents differ in ways that are correlated with their use of health care services, and then our estimated OHP effect may exist biased. The poorer health status reported by OHP beneficiaries may be an of import reason they enrolled in the program, and uninsured Nutrient Stamp recipients did not. (Some, peradventure many, of these Nutrient Postage stamp recipients presumably also had incomes just to a higher place the OHP eligibility threshold.) Although differential wellness condition could innovate selection bias, nosotros accept attempted to partially command for this with three unlike measures of health status in our multivariate analysis.

Option bias may also have been introduced by the high nonresponse rate among Nutrient Stamp recipients. These nonrespondents were more than likely to be Hispanic and presumably were more mobile than those who were able to be located and interviewed. Because Hispanics are more likely to exist uninsured and use fewer health care services (Trevino et al. 1991), our Food Stamp sample undoubtedly includes both more than privately insured recipients and more users of care than the Food Stamp population at large. What are the implications of this nonresponse bias for our study? We controlled for the mix of insured and uninsured by analytically separating the Food Postage stamp sample into ii groups: privately insured and uninsured. Notwithstanding, our utilization estimates for both groups of Nutrient Stamp recipients were almost certainly biased upward. This actually makes for a more than stringent examination of OHP impacts, that is, OHP beneficiaries must meet or exceed the utilization rates of Food Stamp recipients to bear witness that OHP has improved access. Thus, if anything, we may accept underestimated the impact of OHP on admission.

Policy Implications

Many previous studies take shown health insurance improves admission relative to the uninsured, but there have been far fewer studies documenting Medicaid access relative to that of private insurance for low-income populations (Gilt 1999b). Our study plant that OHP nondisabled adults appear to enjoy admission equal or ameliorate than that of low-income adults with individual wellness insurance and far greater admission than the uninsured.

Much of the enhanced access under OHP results from the expansion of eligibility to all Oregonians under 100 percent of FPL. In fact, over two thirds of our sample (68 percent) were expansion beneficiaries, persons who would not have qualified for coverage under traditional Medicaid criteria. Other aspects of OHP, specially its coverage of dental intendance and prescription drugs, also improved access to intendance for its enrollees vis-à-vis privately insured Food Stamp recipients. Thus, OHP eligibility and benefit expansions more than offset any restricted access that might have accompanied mandatory managed care and the priority list.

Footnotes

The research presented in this article was performed under Health Care Financing Assistants Contract No. 500-940056. The statements contained in this article are those of the authors, and no endorsement by Health Care Financing Administration should be inferred or implied.

References

• Bodenheimer T. "The Oregon Health Plan: Lesson for the Nation." New England Periodical of Medicine. 1997;337(9):651–5. [PubMed] [Google Scholar]
• Bograd H, Ritzwoller DP, Calonge N, Shields K, Hanrahan G. "Extending Health Maintenance Organization Insurance to the Uninsured." Journal of the American Medical Association. 1997;277(13):1067–72. [PubMed] [Google Scholar]
• Brown LD. "The National Politics of Oregon's Rationing Program." Wellness Affairs. 1991 Summertime;10:28–51. [PubMed] [Google Scholar]
• Brown JA, Nederend SE, Hays RD, Brusk PF, Farley DO. "Special Issues in Assessing Care of Medicaid Recipients." Medical Intendance. 1999;37(3):MS79–88. [PubMed] [Google Scholar]
• Coughlin T, Long S. Impact of Medicaid Managed Care on Adults: Evidence from Minnesota's PMAP Program. Washington, DC: Urban Institute; 1999. [Google Scholar]
• Fox DM, Leichter HM. "The Ups and Downs of Oregon's Rationing Plan." Health Affairs. 1993;12(two):66–seventy. [PubMed] [Google Scholar]
• Freeman HE, Corey CR. "Insurance Status and Access to Health Services Among Poor Persons." Health Services Research. 1993;28(five):531–42. [PMC costless article] [PubMed] [Google Scholar]
• Freund D, Lewit E. "Managed Care for Children and Pregnant Women: Promises and Pitfalls." The Future of Children. 1993;3(2):92–122. [Google Scholar]
• Golden Grand. "Markets and Public Programs: Insights from Oregon and Tennessee." Journal of Health Politics, Policy and Police force. 1997;22(2):633–66. [PubMed] [Google Scholar]
• Gold Grand. "Beyond Coverage and Supply: Measuring Access to Healthcare in Today's Marketplace." Health Services Research. 1998;33(three):625–52. [PMC free commodity] [PubMed] [Google Scholar]
• Gold M. "Making Medicaid Managed Care Enquiry Relevant." Health Services Enquiry. 33(half dozen):1639–fifty. [PMC free article] [PubMed] [Google Scholar]
• Gold M. "Medicaid Managed Care: Interpreting Survey Information Within and Across States." Inquiry. 36(3):332–42. [PubMed] [Google Scholar]
• Hahn B. "Health Care Utilization: The Result of Extending Insurance to Adults on Medicaid or Uninsured." Medical Care. 1994;32(3):227–39. [PubMed] [Google Scholar]
• Jacobs L, Marmor T, Oberlander J. "The Oregon Wellness Program and the Political Paradox of Rationing: What Advocates and Critics Have Claimed and What Oregon Did." Periodical of Wellness Politics, Policy and Law. 1999;24(i):161–eighty. [PubMed] [Google Scholar]
• Lillie-Blanton M, Lyons B. "Managed Care and Low-Income Populations: Contempo State Experiences." Health Affairs. 1998;17(3):238–47. [PubMed] [Google Scholar]
• Long SH, Marquis MS. "The Effects of Florida'south Medicaid Eligibility Expansion for Pregnant Women." Wellness Services Research. 1998;88(three):371–half dozen. [PMC gratis article] [PubMed] [Google Scholar]
• Martin DP, Diehr P, Cheadle A, Madden CW, Patrick DL, Skillman SM. "Health Care Utilization for the `Newly Insured': Results from the Washington Bones Health Plan." Inquiry. 1997 Summer;34:129–42. [PubMed] [Google Scholar]
• Millman M. Access to Wellness Care in America Institute of Medicine, Committee on Monitoring Access to Personal Wellness Care Services. Washington, DC: National University Press; 1993. [Google Scholar]
• Mitchell JB, Bentley F. "Touch on of Oregon's Priority List on Medicaid Beneficiaries." Medical Care Research and Review. 2000;57(ii):216–34. [PubMed] [Google Scholar]
• Mittler J, Gold M, Lyons B. Kaiser/Republic Low-Income Coverage and Access Project. Menlo Park, CA: The Henry J. Kaiser Family unit Foundation and the Commonwealth Fund; 1999. "Managed Care and Low-Income Populations: Iv Years' Feel with the Oregon Health Plan." [Google Scholar]
• Function for Oregon Health Plan Policy and Inquiry. The Uninsured in Oregon 1998. Salem, OR: Role for Oregon Wellness Plan Policy and Research; 1999. [Google Scholar]
• Rosenbach ML, Irvin C, Coulam RF. "Access for Depression-Income Children: Is Health Insurance Enough?" Pediatrics. 1999;103(half-dozen):1167–74. [PubMed] [Google Scholar]
• Rowland D, Rosenbaum Due south, Simon L, Chait Due east. Medicaid and Managed Care: Lessons from the Literature. A Written report of the Kaiser Commission on the Time to come of Medicaid. Menlo Park, CA: The Kaiser Family Foundation; 1995. [Google Scholar]
• Schoen C, Lyons B, Rowland D, Davis K, Puleo Eastward. "Insurance Matters for Depression-Income Adults: Results from a 5-State Survey." Health Affairs. 1997;16(5):163–71. [PubMed] [Google Scholar]
• Sisk J, Gorman S, Reisinger A, Glied SA, DuMouchel WH, Hynes MM. "Evaluation of Medicaid Managed Care: Satisfaction, Admission and Employ." Journal of the American Medical Association. 1996;276(1):fifty–5. [PubMed] [Google Scholar]
• Steinbrook R, Lo B. "The Oregon Medicaid Sit-in Project: Will It Provide Adequate Medical Care?" New England Periodical of Medicine. 1992;326(5):340–iv. [PubMed] [Google Scholar]
• Szilagyi PG, Zwanziger J, Rodewald LE, Hall JL, Mukamel DB, Trafton S, Shone LP, Dick AW, Jarrell L, Raubertas RF. "Evaluation of a State Health Insurance Program for Depression-Income Children: Implications for Country Kid Wellness Insurance Programs." Pediatrics. 2000;105(ii):363–71. [PubMed] [Google Scholar]
• Trevino FM, Moyer ME, Valdez RB, Stroup-Benham CA. "Health Insurance Coverage and Utilization of Wellness Services by Mexican Americans, Mainland Puerto Ricans, and Cuban Americans." Journal of the American Medical Association. 1991;265:233–vii. [PubMed] [Google Scholar]

---

Articles from Wellness Services Enquiry are provided here courtesy of Health Enquiry & Educational Trust

---

Can I Use Ohp In Another State,

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1430346/

Posted by: cobbalkinst.blogspot.com

Share this post