The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69471

E. Richard Brown, PhD¹, Ronald M. Andersen, PhD², Lillian Gelberg, MD, MSPH³, Andrew B Bindman, MD⁴, Ying-Ying Meng, DrPH¹, Shana A. Lavarreda, MPP⁵, Lida Becerra, MS¹, and Melissa Gatchell⁶. (1) UCLA Center for Health Policy Research, 10911 Weyburn Avenue Suite 300, Los Angeles, CA 90024-2887, 310-794-0812, erbrown@ucla.edu, (2) Department of Health Services, UCLA, 10833 Le Conte Avenue, Room 31-254A CHS, Los Angeles, CA 90024-1006, (3) Department of Family Medicine, UCLA, 50-071 UCLA, Center for Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, (4) Division of General Internal Medicine, University of California, San Francisco, Box 1364, SFGH Bldg 90, Ward 9, University of California, San Francisco, San Francisco, CA 94143, (5) UCLA Center for Health Policy Research, University of California, Los Angeles, 10911 Weyburn Ave. Suite 300, Los Angeles, CA 90024, (6) Center for Health Policy Research, University of California, Los Angeles, 10911 Weyburn Ave., Suite 300, Los Angeles, CA 90024

The study examines how access to physicians and related health services differs among nonelderly adults and children who had consistent or intermittent Medi-Cal and Healthy Families (California’s SCHIP program) coverage in California over the last 12 months, as compared to those who had employer-based insurance or were uninsured for the entire year. The study also focuses on the extent of access differences across population groups and geographic areas. Using data from the California Health Interview Survey (CHIS), a random-digit dial telephone survey, adults (ages 19-64) and children (ages 0-18) below 300% of the federal poverty level were selected for the study. Multilevel models were applied to determine community- and individual-factors associated with current levels of access to care, based on a conceptual model adapted from Andersen et al. Results show sharp decreases in access to care between people who have consistent Medi-Cal or Healthy Families coverage and those who have intermittent coverage. Access decreases further for the persistently uninsured. Compared to employer-based coverage, Medi-Cal and Healthy Families often have comparable levels of access. Access to care among nonelderly adults and children is also significantly related to the existence of strong safety net provider networks, programmatic and community-level characteristics, especially for certain enrollee subgroups, such as those with any chronic condition. Given the current state budget shortfalls, it is anticipated that the proposed cuts will deteriorate access to care for low-income populations by reducing consistent Medi-Cal and Healthy Families coverage and putting a greater strain on the health care safety net.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Articulate the impact of intermittent Medicaid and SCHIP coverage on the access to care.
• Learn how to use a multilevel model to determine individual as well as community factors affecting access to care.

Keywords: Access, Medicaid

Presenting author's disclosure statement:
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.