Managed care penetration, insurance status, and access to health care

BACKGROUND. Access to health care, reflected by an ability to meet one's health needs, is influenced by individual characteristics and the environment. Although managed care activity influences healthcare prices and overall utilization, its relationship to access and its broader effects across different insurance categories has not been well studied. OBJECTIVE. To examine the association between managed care activity and individuals' access to care, and to assess differences in this relationship by insurance status. RESEARCH DESIGN. Cross-sectional survey of households conducted in 1998. SUBJECTS. A sample of 15,613 adult Ohio residents. MEASURES. Self-reported difficulties in obtaining health care, medications, supplies, or medical equipment in the past year. RESULTS. A total of 1248 (8.0%) identified an access problem. In bivariate analyses, these problems were more common among continuously and intermittently uninsured individuals compared with those who were continuously insured during the previous 12 months (P <0.001) and also among those living in areas with more managed care (P = 0.01). After accounting for other individual and environmental characteristics in hierarchical analyses, individuals residing in areas with more managed care had 28% higher odds of reporting problems obtaining care than those elsewhere (multivariate odds ratio, 1.28; 95% confidence interval, 1.04-1.58]; P = 0.02). No significant interaction between managed care penetration and insurance status was observed. CONCLUSIONS. Greater managed care activity is associated with unfavorable patterns of healthcare access despite an individual's insurance status, suggesting more pervasive effects. Unintended effects should be carefully evaluated when formulating future programs that seek to address disparities in access to care.