Access to Care

Reductions in primary and preventive care use under Medicaid primary care case management are more dramatic for minority children

Primary care case management (PCCM) programs pay providers on a fee-for-service (FFS) basis. However, they assign Medicaid patients to gatekeeper providers who must make specific referrals for specialty, emergency, and inpatient care. These programs are designed to increase patients' use of primary and preventive care in doctors' offices, while decreasing use of specialty and urgent care. However, the disruptions in established patterns of care use required by PCCM in Alabama and Georgia had an unexpected negative effect on children, especially minority children, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS10435).

Implementation of PCCM in these two southern States reduced primary care visits for children, both through the direct effect of the gatekeeper role and through changes related to the availability of participating providers. Accounting for provider supply, PCCM was associated with lower use of primary care for all children except white children in urban Georgia. PCCM reduced preventive care for white and black children in urban Alabama and for black children in urban Georgia. In rural Georgia, however, PCCM was associated with increased preventive care among all children.

The negative effect of PCCM was further compounded by negative effects of reduced provider availability. Reductions in office-based Medicaid providers affected Alabama children more often, while reductions in hospital-based Medicaid physicians had a negative effect for Georgia children. Implementation of PCCM without fee increases may affect decisions of providers to participate in Medicaid which, in turn, may have had unexpected negative effects that differentially affected minority children, conclude the researchers. Their findings were based on analysis of Medicaid claims data for children from 1994 through 1997 in Georgia and 1996 through 1999 in Alabama.

See "Effects of primary care case management (PCCM) on Medicaid children in Alabama and Georgia: Provider availability and race/ethnicity," by E. Kathleen Adams, Ph.D., Janet M. Bronstein, Ph.D., and Curtis S. Florence, Ph.D., in the February 2006 Medical Care Research & Review 63(1), pp. 58-87.

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