Hospital service areas in Ibadan city

The catchment areas of the eighteen study hospitals in Ibadan city were identified by the use of the distribution of sampled hospital patients and the distribution of the proportion of patients using the hospitals from each census tract. In the first approach, it was not possible to talk of definable service areas of the hospitals. On the other hand, the second approach revealed well defined service areas for individual hospital as well as groups of hospitals based on their hierarchical order. It was concluded that the service areas of the hospitals in Ibadan city are well defined. The areas most proximate to the hospitals sent the highest proportion of patients. The relevance of the results of the study to identification of the parts of the city not well served by hospitals was also discussed.     

An analysis of market shares of Maryland hospitals in their service areas

The study analyzes market shares (or competitiveness) of Maryland hospitals based on a service area definition of hospitals used for acute care planning in Maryland. The study uses this service area definition to analyze market shares of Maryland hospitals, to test them under alternative hypotheses and, finally, to examine the impact of several key variables. The study finds that proximity of other hospitals, and hospital's occupied bed size, have statistically significant impacts on market shares of hospitals irrespective of hospital location in a metropolitan or rural area.     

Medicaid patients' access to office-based obstetricians

Recent expansion of the eligibility of low-income pregnant women for Medicaid-funded prenatal care may be jeopardized by undersupplies of obstetricians and gynecologists (OB/GYNs) in rural and urban low-income areas and by widely reported declines in the number of OB/GYNs willing to accept Medicaid patients. This paper examines the availability of office-based obstetric care to Medicaid patients in Illinois. We present and test a model of the determinants of Medicaid participation by private, office-based OB/GYNs that highlights the role of residential segregation and practice economics. We find that a large growth in demand for obstetrical care or the enhancement of Medicaid fees is unlikely to have a major effect on OB/GYN participation in Medicaid. We conclude that improving access will require expanding the supply of providers in underserved areas.     

Medicaid expansion under health reform may increase service use and improve access for low-income adults with diabetes

Medicaid's key role in financing diabetes care will grow when many low-income uninsured people with diabetes gain eligibility to the program in 2014 under the Affordable Care Act. Using a national data set to describe current health care use and spending among the nonelderly, low-income adult population, we found that adult Medicaid beneficiaries with diabetes had total annual per capita health expenditures more than three times higher ($14,229 versus $4,568) than those of adult beneficiaries without diabetes. At the same time, Medicaid facilitates financial protection and care access among beneficiaries with diabetes. Low-income adults with diabetes who were uninsured used fewer services, spent more out of pocket, and reported worse access than did their peers who were covered by Medicaid. Uninsured adults with diabetes who gain Medicaid coverage under health reform are likely to enter the program with unmet needs, and coverage is likely to result in both improved access and increased use of health care.     

Older people's mental health in rural areas: Converting policy into service development,service access and a sustainable workforce

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15‐year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence‐based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialist mental health‐residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the “older old,” while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as “hub and spoke” models and step‐up step‐down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery.     

Medicaid managed care and racial differences in satisfaction and access

Many researchers have suggested that the implementation of managed care may lower access to, and quality of, health care services for minorities. However, very little empirical data examining this issue exists. To examine it, the authors used a study design that was both cross-sectional and longitudinal in that they surveyed Medicaid recipients in two counties at two points in time; one of the counties began delivering services through managed care between the two survey periods. Their results indicate that, overall, managed care had neither a positive nor a negative effect on African Americans' access to health care services in either absolute terms or relative to whites'. In addition, race was not found to be associated with satisfaction. However, a Medicaid recipient's race was found to negatively affect his or her access to service under both managed care and fee-for-service systems.     

Loss of Medicaid and access to health services

In this article, the authors assessed the effects of the loss of Medicaid eligibility on access to health services by the medically indigent population in two California counties. An historically derived baseline of health services received by each county's medically indigent adults under Medicaid was compared with the volume of services provided by the county to the same population after they lost Medicaid eligibility. The baseline figures were used as an "expected" volume of services which can be compared with the actual, or "observed," volume of services. The analysis found fewer hospital discharges than expected in Los Angeles and much fewer outpatient visits than expected in Orange County, suggesting that these groups experienced substantial reductions in access related to loss of Medicaid eligibility.     

Capitated Medicaid and St. Joseph's Hospital

This case study presents the initial reactions of St. Joseph's Hospital and Medical Center, a large nonprofit hospital in Phoenix, Arizona, to the creation of a competitively bid, prepaid, managed care Medicaid program in 1982. It also presents the events in the first year of the Medicaid experiment and the subsequent reactions of the hospital. It illustrates the diverse set of issues that a hospital faces when it moves toward greater vertical integration in health care.     

Hospital utilization and expenditures in a Medicaid population.

Determinants of hospital utilization and expenditures are analyzed for Medicaid enrollees in the State Medicaid household sample portion of the National Medical Care Utilization and Expenditure Survey who were continuously enrolled throughout 1980. Health status measures were the best predictors of both the probability of hospitalization and total hospitalizations. Children covered by Aid to Families with Dependent Children were the Medicaid enrollees least likely to be hospitalized. Number of hospital days, surgery, and California residence directly increased hospital expenditures. Conditions responsible for hospitalization increased hospital expenditures indirectly by increasing the number of hospital days and the probability of surgery.     

State Medicaid fees and access to primary care physicians

Medicaid and uninsured patients are disadvantaged in access to care and are disproportionately Black and Hispanic. Using a national audit of primary care physicians, we examine the relationship between state Medicaid fees for primary care services and access for Medicaid, Medicare, uninsured, and privately insured patients who differ by race/ethnicity and sex. We found that states with higher Medicaid fees had higher probabilities of appointment offers and shorter wait times for Medicaid patients, and lower probabilities of appointment offers and longer wait times for uninsured patients. Appointment offers and wait times for Medicare and privately insured patients were unaffected by Medicaid fees. At mean state Medicaid fees, our analysis predicts a 27‐percentage‐point disadvantage for Medicaid versus Medicare in appointment offers. This decreases to 6 percentage points when Medicaid and Medicare fees are equal, suggesting that permanent fee parity with Medicare could eliminate most of the disparity in appointment offers for Medicaid patients. The predicted decrease in the disparity is smaller for Black and Hispanic patients than for White patients. Our research highlights the importance of considering the effects of policy on nontarget patient groups, and the consequences of seemingly race‐neutral policies on racial/ethnic and sex‐based disparities.     

Reimbursement and access to physicians' services under Medicaid.

Several recent studies have shown that physician participation in state Medicaid programs is directly related to the generosity of their reimbursement levels. The implication is that when states reduce fees, Medicaid eligibles suffer because their access to physicians' services is thereby limited. The results presented in this paper do not support this implication. Multivariate analyses of utilization and site-of-visit patterns among non-elderly Medicaid eligibles indicate that stringent physician reimbursement practices do not impede access to ambulatory care when all sites at which a doctor may be seen are considered.