Because Medicaid reimbursements are lower than those of private payers, there has been concern that Medicaid beneficiaries might be experiencing substandard care. Design. A historic, cohort study that used the RAND/UCLA methodology to develop quality indicators of inpatient care for children with asthma; women with a hysterectomy; or, with a complicated delivery. Setting. A representative sample of hospitals in California, Georgia, and Michigan in 1991 was randomly drawn and medical records abstracted. Main outcome measures. Appropriateness of provider decisions to hospitalize for asthma; or, to perform a hysterectomy, or a cesarean section versus a vaginal delivery. For all three conditions, measures of the process of care, and the outcomes. Results. For all three conditions, the appropriateness and process of care were equivalent for the Medicaid and privately insured. However, the data suggested that the Medicaid children and women were admitted to the hospital more seriously ill and with less ambulatory care than the privately insured patients. Medicaid women who underwent surgery were at increased risk of experiencing a complication (hysterectomy - odds ratio (OR) 1.33, 95% confidence interval (CI) 1.05-1.69 and cesarean section OR 1.56, 95% confidence interval (CI) 1.20-2.04). Significant factors included Medicaid coverage, being African American, obesity, first pregnancy and time prenatal care was initiated. Conclusions. An increased severity at admission, less ambulatory care and more postoperative complications among the Medicaid covered despite having care that was equivalent to that of privately insured, suggested that there were problems with access to care before hospitalization.
Learning Objectives: At the conclusion of the presentation, the participant (learner) will be able to: 1. Describe measurement of appropriateness, process and outcomes of health care as indicators of quality. 2. Discuss the advantages of medical record data in assessing quality of care across populations covered by Medicaid or private insurance. 3. Compare the quality of care provided to Medicaid covered patients with that of privately insured patients based on accepted standards of clinical decision making.
Keywords: Quality of Care, Medicaid
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.