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Satisfaction, Access, and Use

Jane E. Sisk, PhD; Sheila A. Gorman, PhD; Anne Lenhard Reisinger, PhD; Sherry A. Glied, PhD; William H. DuMouchel, PhD; Margaret M. Hynes, PhD

JAMA. 1996;276(1):50-55.

Abstract
Objective.
—To evaluate the effects of managed care on Medicaid beneficiaries' satisfaction with, access to, and use of medical care during early implementation of an enrollment initiative.

Design.
—Cross-sectional survey of a random sample of Medicaid beneficiaries in 5 managed care plans and in the conventional Medicaid program.

Setting.
—New York, NY.

Participants.
—Adults aged 18 to 64 years who received Medicaid insurance benefits through Aid to Families With Dependent Children or State Home Relief and had been enrolled in a managed care plan or receiving benefits under conventional Medicaid for at least 6 months. Of the 2500 enrollees in managed care plans and the 600 other beneficiaries in conventional Medicaid whom we surveyed, 1038 enrollees and 410 nonenrollees responded.

Outcome Measures.
—Beneficiaries' ratings of overall satisfaction and 13 dimensions of satisfaction related to access, interpersonal and technical quality, and cost; reports of access, including regular source (location) of care, waiting time for appointment, waiting time in office, and ability to obtain care; and reports of use, including inpatient, emergency department, and ambulatory visits.

Results.
—Compared with beneficiaries in conventional Medicaid, managed care enrollees in general gave higher ratings of satisfaction. The results were not consistent, however, between the proportion who were extremely satisfied and the proportion who were extremely dissatisfied. Managed care enrollees had significantly greater odds of being extremely satisfied (excellent and very good ratings), but fewer differences were statistically significant for levels of extreme dissatisfaction (fair and poor ratings). With regard to access, managed care enrollees had significantly greater odds of having a usual source of care (odds ratio [OR], 2.33) and seeing the same clinician there (OR, 2.72) and had significantly shorter appointment and office waiting times. Managed care and conventional Medicaid beneficiaries reported no significant differences in obtaining or delays in getting needed care and in inpatient or emergency department use.

Conclusions.
—Medicaid managed care enrollees in New York City reported better access to care and higher levels of satisfaction compared with conventional Medicaid beneficiaries. Differences between these findings and those for privately insured populations highlight the pitfalls of generalizing from other groups to Medicaid for policy purposes. Given growing reliance on consumer satisfaction surveys for clinical and public policy, future research should focus on factors that explain extreme satisfaction vs extreme dissatisfaction. New York State's initiative, which has been associated with careful state and local monitoring, merits continuing evaluation as managed care enrollment grows and may become mandatory.

Author Affiliations
From the School of Public Health (Drs Sisk, Gorman, Reisinger, Glied, and DuMouchel) and Department of Economics (Dr Glied), Columbia University, New York, NY; and University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway (Dr Hynes).

Footnotes
Reprints not available from the author.

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