2009 May » Medicare and Medicaid News

Am J Public Health, Vol. 98, No. 11. (2008), 1987-95.

OBJECTIVES: We examined disparities in health care use among US-Mexico border residents, with a focus on the unique binational environment of the region, to determine factors that may influence health care use in Mexico. METHODS: Data were from 2 waves of a population-based study of 1048 Latino residents of selected Texas border counties. Logistic regression models examined predictors of health insurance coverage. Results from these models were used to examine regional patterns of health care use. RESULTS: Of the respondents younger than 65 years, 60% reported no health insurance coverage. The uninsured were 7 and 3 times more likely in waves 3 and 4, respectively, to use medical care in Mexico than were the insured. Preference for medical care in Mexico was an important predictor. CONCLUSIONS: For those who were chronically ill, old, poor, or burdened by the lengthy processing of their documents by immigration authorities, the United States provided the only source of health care. For some, Mexico may lessen the burden at the individual level, but it does not lessen the aggregate burden of providing highly priced care to the region's neediest. Health disparities will continue unless policies are enacted to expand health care accessibility in the region.
E Bastida, Brown, JA Pagan

Am J Manag Care, Vol. 11, No. 3. (2005), 156-64.

OBJECTIVE: To assess differences in care management practices for Medicaid beneficiaries in predominantly commercial and predominantly Medicaid health plans. STUDY DESIGN: Physicians in the networks of 8 managed care plans participating in Medicaid programs were surveyed regarding the availability and usefulness of care management practices and the overall quality of care management. The responses of physicians in plans serving predominantly Medicaid enrollees were contrasted with the responses of physicians in predominantly commercial plans who cared for Medicaid enrollees. METHODS: Logistic regression analysis was used to calculate adjusted odds ratios relating to the availability of care management practices. Multiple regression techniques were used to construct comparisons of adjusted means relating to the usefulness of practices and the overall quality of care management. RESULTS: Physicians in predominantly commercial plans reported greater availability of care management practices. No patterns of differences were noted in ratings of the usefulness of practices if available. Physicians in predominantly commercial plans rated the quality of care management higher than physicians in predominantly Medicaid plans. However, there remains room for substantial improvement for commercial and other Medicaid contracting plans. CONCLUSIONS: Commercial plans add value to Medicaid programs, and efforts to discourage their withdrawal from participation are justified. However, physician evaluations support the potential for better care management in all types of contracting plans.
GH Avery, DR Wholey, JB Christianson

Medicare and Medicaid News

Effectiveness of a community coalition for improving child vaccination rates in New York City

Persistent disparities in the use of health care along the US-Mexico border: an ecological perspective

Physician evaluations of care management practices in Medicaid programs