How Managed Care Growth Has Affected Health Departments’ and Physicians’ Ability to Provide Indigent Care

To what extent have increases in managed care affected the provision of care for the uninsured by local health departments (LHDs) and physicians? Researchers at the University of Pittsburgh analyzed whether managed care has: 1) diverted Medicaid revenues away from LHDs, reducing their cross-subsidization and provision of care for the uninsured; 2) decreased the Medicaid revenue of doctors employed by organizations with a mission to serve the uninsured, and decreased these physicians’ charity care; 3) decreased physicians’ autonomy, leading to decreased charity care; 4) decreased LHDs’ ability to ensure access; and 5) reduced trust in medical providers among the uninsured, leading to lower utilization. They used two rounds of the CTS Household and Physician Surveys, InterStudy data, American Hospital Association data, the Area Resource File, and a representative survey of 240 LHDs in his analyses. The project explored why high levels of managed care penetration are associated with reduced access among the uninsured, and developed policy implications from the study’s findings, describing unforeseen consequences of recent policies, and assessing implications for future policy.