The purpose of this study was to compare children’s access to health care, and families’ satisfaction with that care, in 15 rural counties in Florida’s Title XXI Healthy Kids Program under two models of service delivery: Exclusive Provider Organizations (EPO; 5 rural counties) and Health Maintenance Organizations (HMO; 10 rural counties). In contrast to HMOs, which use gate-keepers to regulate access to health care and often use capitated arrangements, EPOs do not use gate-keepers, thereby allowing members relatively unrestricted access to medical services, and often reimburse providers on a fee-for-service basis. In this study, access to care was operationalized (1) from parents’ perspective via survey data (150 EPO and 150 HMO enrollees) and (2) based on enrollment files and claims and encounter data submitted by the health plans. Analyses to date have been conducted with the enrollment and claims and encounter data. First, comparisons of the mean number of doctor visits per year by plan model revealed that EPO enrollees saw the doctor more often than HMO enrollees. Second, two sets of comparisons were run: actual to expected use; and actual to expected use (controlling for site case-mix). These analyses also revealed differences in access to care based on service-delivery model: EPO enrollees used more health services than HMO enrollees; this pattern remained even after controlling for case-mix. Analyses of survey data are underway to examine parents’ perceptions of access to care (e.g., number of visits/year; ease of seeing physician; unmet need) and how satisfied they are with that care.
Learning Objectives: n.a.
Keywords: Managed Care, Access to Health Care
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