Jennifer N. Edwards, Janet Bronstein and David B. Rein
"Do Enrollees in 'Look-Alike' Medicaid and SCHIP Programs Really Look Alike?," Jennifer N. Edwards, Janet Bronstein, and David B. Rein, Health Affairs 21, 3 (May 2002): 240248
Georgia presents a unique opportunity to compare the experiences of children enrolled in Medicaid with those enrolled in the State Children's Health Insurance Program (SCHIP), the two federal-state programs that provide health coverage to low-income children. After all, PeachCare for Kids—the state's version of SCHIP—has benefit, provider, and reimbursement structures that are nearly identical to Georgia Medicaid. As this study shows, however, health care utilization and satisfaction differ markedly between the two programs, despite structural similarities.
According to the Health Affairs study "Do Enrollees in 'Look-Alike' Medicaid and SCHIP Programs Really Look Alike?," by Jennifer N. Edwards of The Commonwealth Fund, Janet Bronstein of the University of Alabama, and David B. Rein of Georgia State University, children enrolled in Georgia Medicaid use medical services less often and their parents are generally less satisfied with the care their children receive than those enrolled in PeachCare. Although the mean age (8.7 years) and gender composition (54% male) were found to be similar among Medicaid and PeachCare enrollees, the researchers found that Medicaid children were far more likely to be without a primary care provider (31% Medicaid vs. 19% PeachCare), and their parents reported more problems getting help on the telephone, making appointments, and seeing specialists. Medicaid children were also twice as likely as PeachCare enrollees not to have visited a doctor in the prior six months (26% vs. 13%).
Furthermore, overall satisfaction with care was lower among Medicaid respondents. More Medicaid than PeachCare parents felt, for example, that their physicians did not spend enough time with their children (15% vs. 9%) and that support staffs were unhelpful (13% vs. 8%).
Georgia Medicaid, however, did seem to perform better than PeachCare on certain measures. Medicaid children were found to be less likely to have long waits in the doctor's office, and their parents had less difficulty finding a satisfactory primary care provider. For example, 64 percent of PeachCare enrollees reported waiting more than 15 minutes to see a provider, compared with only 33 percent of Medicaid enrollees.
For their study, the authors surveyed both PeachCare and Medicaid populations using the Consumer Assessment of Health Plans Survey (CAHPS) and held focus groups with each population and with care providers. They then performed analyses that took into account several demographic characteristics, including race, parental education, rural/urban location, special health needs, and child's age. Differences in race and education were found to be associated with different levels of reported access. For example, those reporting their race as black were less likely to have a personal physician, to have visited a doctor in the prior six months, and to have seen a specialist as needed.
Three possible explanations for these differences in use and satisfaction require further study, the authors say. They include: