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PubMedDate not supplied

Quality care in a medicaid managed care program: adequacy of prenatal care for teens in Chicago.

This study considers whether obstetricians offer less adequate care to teen prenatal patients in the Healthy Moms, Healthy Kids (HMHK) Medicaid managed care program in Chicago than to non-Medicaid patients. Telephone surveys of obstetricians offices (n = 101) were conducted to determine the content of care in the first prenatal visit. These survey data are combined with demographic and practice background data from The American Medical Association's Physician Master File. Analysis indicates there were no significant differences between groups for receiving: (1) medical histories, (2) physical exam and tests, (3) health promotion counseling, and (4) availability of birthing education materials. Analysis further indicates, however, that teen Medicaid patients are less likely to receive blood tests and some urinalysis-related tests. Not receiving these tests is especially problematic because pregnant teens are more likely to drop out of the prenatal care regimen after their first visit, and teens are more likely to have poorer birth outcomes.

Adolescent↗
PubMed1999

A comparison study of access to health care under a Medicaid managed care program.

This article investigates the health care and insurance status of a low-income urban area in East Tennessee. The article reviews the background of TennCare, a compulsory Medicaid managed care program initiated in Tennessee in 1994. The study compared TennCare recipients with other insurance groups on key demographic and access variables. Possible explanations for how TennCare recipients rate their care also were examined. Qualitative analysis revealed accounts of long waiting periods, out-of-town specialist care, problems with obtaining pharmaceuticals, and general confusion about the new system. Implications of these findings for social work policy practitioners are discussed, and suggestions for alleviating the burden on patients are offered.

Adult↗
PubMedDate not supplied

[A proposed open formulary for a managed care program in Mexico. The Therapeutic and Pharmacological Committee of Mexico].

OBJECTIVE: To integrate an open formulary with drug use recommendations in which a physician could find a wide range of therapeutic options for his private practice. MATERIAL AND METHODS: An interdisciplinary medical committee with a high scientific level, reviewed each one of all the drugs available to be sell in Mexico, as part of a Pharmacy Benefit Management & Manage Care program implemented in our country. Each drug was classified according to its active ingredient under one of the following categories: 1) essentials, 2) excluded, and 3) not essentials-not excluded. The decision in each case was based on pure scientific grounds and using an Evidence-Based Medicine analysis. RESULTS: The proposed formulary contains a total of 1106 active ingredients-either unique or in combination-, from which 429 (38.8%) were classified as essentials. About one-out-of-ten drugs (8.7%) currently in use within the private medical practice in Mexico, some of them highly prescribed, were regarded by the committee as excluded due to concerns about their efficacy and/or safety. CONCLUSIONS: On this report a detailed description of the process followed to conform the committee, its objectives an its performing criteria is presented, as well as the bases under which the final list of drugs of the formulary were set.

Formularies as Topic↗
PubMed2001

Satisfaction with services in innovative managed care programs for groups of traditionally underserved individuals with HIV/AIDS: empirical models.

As the number of people with HIV/AIDS receiving services in managed care models increases, concerns over quality of care and satisfaction with services have grown. This article examined data from three national demonstration projects that were funded to enroll traditionally underserved individuals and provide innovative medical services in programs developing models appropriate for managed care funding. Assessments of patient satisfaction were related to indicators of traditionally underserved status including demographic characteristics, behaviors, and other risk factors using the data modeling method of Exhaustive CHAID (Chi-squared Automatic Interaction Detector). Overall patient satisfaction levels with these programs were very high. Through the modeling methods, the groups most likely to experience the greatest program satisfaction are identified. In general, all groups were highly satisfied with the programs.

Adult↗
PubMed1999

Patient satisfaction and loyalty among military healthcare beneficiaries enrolled in a managed care program.

OBJECTIVE: A study was performed to evaluate military beneficiaries' motivation for choosing to change from a civilian managed care system to the military managed care system. BACKGROUND: Concerns about healthcare cost, quality, and access underpin major reform in military healthcare. The military health system (MHS) is implementing managed care through an initiative known as TRICARE. Patient choice and satisfaction are highly relevant to all healthcare delivery systems; they are being explored aggressively in the MHS as TRICARE evolves. METHODS: This descriptive study was conducted using a telephone survey consisting of 63 items derived from four pre-existing instruments as well as five facility-specific questions and demographics. The population of interest targeted military beneficiaries on a TRICARE waiting list who, at the time of enrollment, indicated a desire to receive care at the military facility. RESULTS: Consumers were inclined to return to the military system because of loyalty. Also, this study provided evidence that staff courtesy is important to those who seek healthcare. Good quality and accessibility were verified as essential elements in sustaining a consumer's positive view of and attraction to a particular healthcare system. Cost was proven to be a less substantial factor of consumer decision making. CONCLUSIONS: Surveys such as this give healthcare providers more information about aspects of care, such as patient loyalty and interpersonal dynamics, that attract people to their healthcare delivery systems. For healthcare systems to thrive, consumer influence and the power of patient dissatisfaction must be understood.

Contract Services↗
PubMed2001

Public hospitals and substance abuse services for pregnant women and mothers: implications for managed-care programs and Medicaid.

Although an increasing proportion of the US population receives health services through managed care, pregnant women and mothers eligible for Medicaid who are involved with alcohol or other drugs are often excluded from these programs due in large part to lack of information on costs, service needs, and service use. To develop such information policy, service settings, and managed-care plans, the project conducted a national survey using a provider group with experience in caring for this population, the member universe of the National Association of Public Hospitals and Health Systems. The survey requested detailed information on hospital system information, current managed-care arrangements, outcome measurements, financing, service priorities, and service availability. The 81% response rate (n = 95) identified 35 hospital systems providing services to an average of 998 women in 1997. The majority of these systems (69%) reported coordinating care for these patients, but only 26% reported they computerize patient charts. Most use at least one indicator to measure effectiveness, and 50% use at least four. Counseling/education and transportation were seen as key support services, but many acknowledge they are not reimbursed for critical services such as nutrition education. The discussion highlights the need to provide formal support for core support services, to assist in care coordination and provide incentives for developing more sophisticated information, and to specify related services in the state Medicaid contract language.

Attitude of Health Personnel↗
PubMed2004

Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program.

AIMS: This study compared 5-year treatment outcomes of older adults to those of middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome. DESIGN: Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline). MEASUREMENTS: Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records. FINDINGS: Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years; female gender was also significant. CONCLUSIONS: Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.

Adolescent↗