Examining Access to Care in Medicaid and CHIP

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March 2011

Chapter 4 of MACPAC’s inaugural 2011 report lays out an initial framework for measuring access. The framework, which focuses on primary and specialty care providers and services, has three main elements: enrollees and their unique characteristics, availability, and utilization. It accounts for factors such as geographic location, cultural diversity, and discontinuous eligibility along with enrollees’ income levels and health care needs.

Availability of providers is also significant to access, and is influenced by overall supply and provider participation. Utilization encompasses whether and how services are used, the affordability of services, and how easily enrollees can navigate the health system. In addition, the Commission will evaluate overall access in terms of the appropriateness of services and settings for care; efficiency, economy, and quality of care; and overall health outcomes.

The framework aims to shape future work on evaluating access to services for Medicaid and CHIP enrollees as well as provide the basis for an early-warning system for areas with provider shortages and other factors that could adversely affect Medicaid and CHIP enrollees’ health and access to care. Read more about MACPAC’s access framework, which focuses on primary and specialty care providers and services.

Publication Type: Reports to Congress

From: March 2011 Report to the Congress on Medicaid and CHIP

Tags: access, CHIP, comparisons with other sources of coverage, data, encounter data, fee for service, health status, managed care, oversight, provider participation, spending, survey data