Author | Year | Sample Size | Data Source | Study Design | Access Measure | Statistic | Comparison | Findings | Endogeneity/Selection |
---|---|---|---|---|---|---|---|---|---|
Alessandrini et al. [37] | 2001 | 553 | Single hospital | Prospective cohort | Utilization | χ2; % with a specialty visit; number of visits | Managed care vs. fee-for-service | 10% vs. 12%, p = 0.68; 0.2 vs. 0.2, p = 0.65 | MC mandated' no patient selection |
Cartland and Yudkowsky [43] | 1992 | 1,264 | American Academy of Pediatrics Fellows | Cross-sectional | Referral rates | χ2; frequency of referral of MCO patients | Managed care vs. fee-for-service | More frequent: 2.5%; less frequent, 8.7%; p < 0.05 | Study is of physician behavior; no patient selection |
Cuesta et al. [44] | 2000 | 49 | Single hospital | Retrospective cohort | Referral type | χ2 | Initial referral is to rheumatologist vs. orthopedic surgeon | Managed care: 83% vs. 17%; "Traditional commercial": 58% vs. 42%; p = NS | Examines insurance type at initial referral, prior to diagnosis |
Ferris et al. [39] | 2002 | 59,952 | Single MCO | Quasi-experimental | Utilization | t-test; number of specialist visits and proportion new specialist visits | With gatekeeping vs. without gatekeeping | Visits: 0.28 vs. 0.28, p = NS; % new visits: 30.6% vs. 34.8%; p < 0.05 | Single MCO initiated removal of gatekeeping; no patient choice |
Ferris et al. [45] | 2001 | 1,839 | Single insurance plan | Prospective cohort | Utilization | t-test; change in visits | Gatekeeping vs. indemnity | 57% decrease vs. 31% increase; p = 0.005 | Patient voluntarily selected into coverage type |
Forrest et al [24] | 1999 | 27,104 | National practice-based research network | Prospective | Referral rates | t-test, percent referred; logistic regression, likelihood of referral to specialty | Gatekeeping vs. no gatekeeping | Medicaid, OR = 1.86, p < 0.001; Private, OR = 1.76, p < 0.01 | No consideration of selection into type of plan |
Garrett et al [38] | 2003 | 34,280 | National Health Interview Survey | Retrospective | Utilization | Probit; mandatory PCCM vs. FFS, mandatory HMO vs. FFS; likelihood of any specialist visit | Fee-for-service vs. primary care case management or HMO | PCCM = 0.003, p = NS; HMO = 0.378, p < 0.05 | Mandatory enrollment into program type |
Lake [46] | 1999 | 12,383 | Community Tracking Survey | Cross-sectional | Satisfaction | Logistic regression; difference in percent satisfied with choice of specialists | HMO vs. non-HMO | -8.3%, p < 0.05 | No consideration of selection into coverage type |
Mitchell, Khatutsky, and Swigonski [40] | 2001 | 966 | Single SCHIP | Cross-sectional | Unmet need | χ2; percent with unmet need for specialist | Managed care vs. fee-for-service | 6.0% vs. 10.6%, p = NS | Patients seek managed care exemptions |
Perlstein et al. [15] | 1997 | 544 | Regional cardiac registry | Retrospective cohort | Time to referral | t-test; mean age at referral | Managed care vs. "commercial" | 140 days vs. 80 days, p < 0.05 | No consideration of selection into coverage type |
Price et al. [34] | 1999 | 94 | Single hospital | Cross-sectional | Utilization | t-test; number of specialist visits | Capitated plan vs. fee-for-service | All: 7.5 vs. 6, p = NS; asthma-related: 5 vs. 4, p,0.05 | No consideration of selection into coverage type |
Roberto et al. [53] | 2005 | 935 | Single Medicaid program | Quasi-experimental | Utilization | Probit; change in access to specialist | Fee-for-service vs. partially capitated managed care | b = 0.221, p < 0.05 | Voluntary selection into plan type |
Shenkman at al. [42] | 2004 | 2,333 | Single SCHIP | Cross-sectional | Utilization | Logistic regression; likelihood of a specialist visit | Plans with certain managed care characteristics vs. those without | Percent paid on FFS basis: 0.950, p = 0.003; Bonus for quality profile: 1.714, p = 0.0003 | Mandatory enrollment into specific plan |
Shields, et al. [41] | 2002 | 6,231 | Single Medicaid program | Cross-sectional | Utilization | Logistic regression; likelihood of specialist visit | HMO vs. primary care case management plan | OR = 1.80, p < 0.05 | Voluntary selection into coverage type |