Doctoral Dissertation Research in Political Science: The Politics of States' Medicaid Managed Care: 1981-1998

本博士论文研究调查的长期目标是为了更好地了解有关国家一级政策制定者制定的方案设计的决策如何影响目标人群通过医疗补助使用国家支持的医疗保健。具体来说，该研究有以下目标：首先，该研究试图确定哪些环境（健康、经济和社会）和政治因素影响了各州要求豁免医疗补助计划的决定？第二，为什么各州在医疗补助管理医疗项目的设计和复杂程度上各不相同？最后，管理式医疗项目的变化会影响医疗服务的提供吗？具体来说，获得医疗服务的途径和医疗费用是否因设计而异？为了回答这些问题，将采用多种设计和统计程序。使用1981年至1998年50个州的事件计数方法解释了获得豁免概率增加的决定因素。为了解决项目多样性、可及性和成本的问题，我们将采用一套联立方程模型。创建索引既可以作为独立变量，也可以作为因变量。本研究将使用卫生保健财务管理数据以及博士研究生收集的其他数据。

The long term objective of this Doctoral Dissertation Research Investigation is to better understand how decisions with regards to program design made by state level policy makers affect the target populations use of state supported health care through Medicaid. Specifically, the research has the following goals: First, the research seeks to determine what environmental (health, economic, and social) and political factors shape the decisions of states to request Medicaid program waivers? Second, why do states vary in their design and complexity of managed care programs in Medicaid? Finally, do variations in managed care programs affect the delivery of health care? Specifically, does the access to care and the cost to state vary by design? To answer these questions multiple designs and statistical procedures will be employed. An event count approach using the 50 states from 1981 through 1998 provides an explanation of the determinants of an increased probability to obtain a waiver. To address the issues of program diversity, access, and cost a set of simultaneous equation models will be employed. Indices are created to serve both as independent and dependent variables. Health Care Financing Administration data as well as additional data collected by the Ph.D. student will be used in this study.