MULTIMETHOD ASSESSMENT OF MEDICAID MANAGED CARE

1997年，新墨西哥州启动了一项医疗补助计划 管理式护理（MMC）。 研究这次改革的效果很重要 在新墨西哥州，由于先前对管理式医疗的研究已经提出了 关于其适用性和潜力的实质性问题， 在主要是农村、贫穷和少数民族的地区成功实施 不同的国家。 我们的项目涉及三个具体目标，它们来自一个 一个概念模型，跟踪医疗保健改革的影响， 个人、组织/社区和人口分析水平： 1)评估个人的可及性、满意度、目标医疗保健 实施MMC前后的结果和护理费用。 我们 将通过侧重于地理的调查方法来实现这一目标， 低收入居民比例高的地区。 此组件 将使我们能够研究这些关键指标的变化， 医疗补助患者中的水平，符合医疗补助条件但不符合 登记，那些由其他公共和私人保险计划， 和无保险的人 2)检查MMC改革对安全的影响- 为高危群体和社区提供服务的网络机构。 民族志研究方法将通过关注以下方面来实现这一目标： 收入支持办公室、社区卫生中心、急诊室， 私人医生办公室和管理式医疗机构， 城乡发展 3)为了衡量可预防的、不利的 哨点健康结果。我们将通过研究来实现这一目标 管理数据库，提供有关可预防 在人口水平上的成果。 该项目涉及一个跨学科的研究人员团队， 新墨西哥州大学的几个学术单位，以及 新墨西哥州卫生部的调查人员。 该项目将提供有关MMC影响的实用知识 可以指导新墨西哥州和其他州未来的政策决定 农村和种族多样的人口。 多方法方法 结合调查工作，人种学观察， 行政数据库将开辟新的领域， “三角测量”的补充方法，以得出结论， MMC的多方面影响。 这一方法学上的进步将证明 有助于国家和其他国家评估未来的 卫生政策的变化。

During 1997, the State of New Mexico initiated a program of Medicaid managed care (MMC). It is important to study the effects of this reform in New Mexico, since prior research on managed care has raised substantial questions about its applicability and potential for successful implementation in predominantly rural, poor, and ethnically diverse states. Our project addresses three specific aims, which derive from a conceptual model that traces the effects of health care reform at the individual, organizational/community, and population levels of analysis: 1) To assess individuals'=access, satisfaction, targeted healthcare outcomes, and costs of care before and after implementation of MMC. We will address this aim through survey methods focusing on geographical areas with a high proportion of low-income residents. This component will allow us to study changes in these key indicators at the individual level among Medicaid patients, persons eligible for Medicaid but not enrolled, those covered by other public and private insurance programs, and the uninsured. 2) To examine the effects of MMC reform on safety- net institutions serving at-risk groups and on communities. Ethnographic research methods will address this aim by focusing on income support offices, community health centers, emergency departments, private practitioners' offices, and managed care organizations in both urban and rural areas. 3) To measure changes in preventable, adverse sentinel health outcomes. We will accomplish this aim through the study of administrative databases which provide information about preventable outcomes at the level of the population. The project involves an interdisciplinary team of researchers, spanning several academic units at the University of New Mexico, as well as investigators with the New Mexico Department of Health. This project will provide practical knowledge about the impact of MMC that can guide future policy decisions in New Mexico and other states with rural and ethnically diverse populations. The multimethod approach of combining survey work, ethnographic observations, and study of administrative databases will break new ground in permitting a "triangulation" of complementary methods to reach conclusions about the multifaceted impacts of MMC. This methodologic advance will prove helpful nationally and in other states for the evaluation of future health policy changes.