Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees
Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees
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DOI：
10.1001/jamainternmed.2017.3766
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发表时间：
2017-10-01
影响因子：
39
通讯作者：
Cleary, Paul D.
中科院分区：
文献类型：
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作者：
Ndumele, Chima D.;Cohen, Michael S.;Cleary, Paul D.
重要的是，医疗补助受助人一直报告说，与其他类型的保险患者相比，他们更不及时地获得专家的帮助。到2018年，医疗保险和医疗补助服务中心（CMS）将要求州医疗补助机构为管理式护理组织制定时间和距离标准，以确保为注册者提供充足的专科医生;但是，在此情况下，还没有发表的研究，这些政策是否有显着的影响，以获得专业护理。目的比较评级的专家为成人医疗补助和设计、设置和参与者我们使用医疗保健提供者和系统的消费者评估调查数据，对采用访问标准的5个州的20163名非老年人医疗补助管理护理（MMC）参与者和54465名商业保险参与者进行了准实验差异（DID）分析，和37290 MMC登记在5个匹配的国家，以前采用的访问standards.Main结果和措施报告访问专科护理在过去6 months.Results七千六百九十八（69%）Medicaid登记和28423（75%）商业登记者报告说，在政策实施之前，总是或通常很容易与专家预约（或在基线）相比，11889（67%）的医疗补助登记者在以前实施的访问标准。总体而言，在实施标准后的一段时间内，MMC注册者及时获得专业服务的情况没有显著改善（调整后的差异-无差异，-1.2个百分点; 95% CI，-2.7至0.1），也没有任何基于保险的获得差异的影响（0.6个百分点; 95% CI，-4.3至5.4）。有异质性的国家，与1个国家，实施时间和距离的标准，表现出显着的改善，在访问和减少的差距。结论和相关性专业访问标准并没有导致广泛的改善，在访问专科医生。医疗补助受助人获得专科护理的有意义的改善可能需要额外的干预措施。
IMPORTANCE Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care.OBJECTIVE To compare ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards.DESIGN, SETTING, AND PARTICIPANTS We used Consumer Assessment of Healthcare Providers and Systems survey data to conduct a quasiexperimental difference-in-differences (DID) analysis of 20 163 nonelderly adult Medicaid managed care (MMC) enrollees and 54 465 commercially insured enrollees in 5 states adopting access standards, and 37 290 MMC enrollees in 5 matched states that previously adopted access standards.MAIN OUTCOMES AND MEASURES Reported access to specialty care in the previous 6 months.RESULTS Seven thousand six hundred ninety-eight (69%) Medicaid enrollees and 28 423 (75%) commercial enrollees reported that it was always or usually easy to get an appointment with a specialist before the policy implementation (or at baseline) compared with 11 889 (67%) of Medicaid enrollees in states that had previously implemented access standards. Overall, there was no significant improvement in timely access to specialty services for MMC enrollees in the period following implementation of standard(s) (adjusted difference-indifferences, -1.2 percentage points; 95% CI, -2.7 to 0.1), nor was there any impact of access standards on insurance-based disparities in access (0.6 percentage points; 95% CI, -4.3 to 5.4). There was heterogeneity across states, with 1 state that implemented both time and distance standards demonstrating significant improvements in access and reductions in disparities.CONCLUSIONS AND RELEVANCE Specialty access standards did not lead to widespread improvements in access to specialist physicians. Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions.