Restricting medicaid payments for transportation: Effects on inner-city patients' health care

William M. Tierney, Lisa E. Harris, Denise L. Gaskins, Xiao Hua Zhou, George J. Eckert, Ann S. Bates, Fredric D. Wolinsky

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Prior approval programs have been used to control spiraling costs of Medicaid, but they are rarely formally assessed. We evaluated the effect of a change in Indiana Medicaid's policy (effective October 1, 1993) requiring prior approval to pay transportation costs. Methods: We performed a historical cohort study comparing the health care utilization of Medicaid patients during the first 6 months of 1993 versus the first 6 months of 1994. Subjects included all Medicaid patients who visited any inpatient or outpatient site affiliated with an inner-city public hospital in the first 6 months of 1993 (N = 23,015) and 1994 (N = 23,707). Results: These Medicaid patients made 82,961 visits in the first 6 months of 1993 and 79,809 visits in the first 6 months of 1994. Visits to hospital-based primary care clinics declined 16% (P < 0.001), which was partially offset by a 7% increase in visits to neighborhood health centers (P ≤ 0.001). Emergency and urgent visits fell by 8%; visits for medication refills fell by 18% (P < 0.001 for each). Hospitalizations increased slightly in 1994, with no change in the number of inpatient days. There was no change in inpatient or outpatient nontransportation charges. There were no systematic reductions in selected aspects of preventive care. However, there were fewer emergency and urgent visits among patients with reactive airway disease. Conclusions: Requiring prior approval for transportation was associated with reductions in visits for primary care visits and refilling prescriptions without measurable short- term effects on charges or selected clinical parameters. Neighborhood health centers partially ameliorated the decline in primary care visits.

Original languageEnglish
Pages (from-to)326-333
Number of pages8
JournalAmerican Journal of the Medical Sciences
Volume319
Issue number5
StatePublished - May 2000

Fingerprint

Medicaid
Patient Care
Delivery of Health Care
Community Health Centers
Inpatients
Primary Health Care
Emergencies
Outpatients
Patient Acceptance of Health Care
Preventive Medicine
Cost Control
Public Hospitals
Urban Hospitals
Prescriptions
Hospitalization
Cohort Studies
Costs and Cost Analysis

Keywords

  • Clinical epidemiology
  • Health policy
  • Medicaid
  • Vulnerable populations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tierney, W. M., Harris, L. E., Gaskins, D. L., Zhou, X. H., Eckert, G. J., Bates, A. S., & Wolinsky, F. D. (2000). Restricting medicaid payments for transportation: Effects on inner-city patients' health care. American Journal of the Medical Sciences, 319(5), 326-333.

Restricting medicaid payments for transportation : Effects on inner-city patients' health care. / Tierney, William M.; Harris, Lisa E.; Gaskins, Denise L.; Zhou, Xiao Hua; Eckert, George J.; Bates, Ann S.; Wolinsky, Fredric D.

In: American Journal of the Medical Sciences, Vol. 319, No. 5, 05.2000, p. 326-333.

Research output: Contribution to journalArticle

Tierney, WM, Harris, LE, Gaskins, DL, Zhou, XH, Eckert, GJ, Bates, AS & Wolinsky, FD 2000, 'Restricting medicaid payments for transportation: Effects on inner-city patients' health care', American Journal of the Medical Sciences, vol. 319, no. 5, pp. 326-333.
Tierney WM, Harris LE, Gaskins DL, Zhou XH, Eckert GJ, Bates AS et al. Restricting medicaid payments for transportation: Effects on inner-city patients' health care. American Journal of the Medical Sciences. 2000 May;319(5):326-333.
Tierney, William M. ; Harris, Lisa E. ; Gaskins, Denise L. ; Zhou, Xiao Hua ; Eckert, George J. ; Bates, Ann S. ; Wolinsky, Fredric D. / Restricting medicaid payments for transportation : Effects on inner-city patients' health care. In: American Journal of the Medical Sciences. 2000 ; Vol. 319, No. 5. pp. 326-333.
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