Low-income persons' access to health care: NMCUES Medicaid data

Data from the National Medical Care Utilization and Expenditure Survey (NMCUES) are presented on access to medical care for low-income people in 1980. NMCUES was a national probability household survey jointly sponsored by the National Center for Health Statistics and the Health Care Financing Administration. NMCUES also included four State Medicaid Household Surveys. Data from both the national sample, for all low-income people, and from the four State surveys, for Medicaid people, were included in this analysis. The NMCUES data provided several measures which were previously unavailable on Medicaid experience, in particular, detailed Medicaid eligibility information in combination with income, health status, and health care use. This information can provide a comparison between access to care for those covered by Medicaid, and other low-income persons. In 1980 Medicaid covered a minority of poor and low-income people, only 44 percent of the poor younger than 65 years of age and 38 percent of poor people 65 years of age and older. While almost all elderly had Medicare coverage, about 25 percent of younger low-income people had no form of health insurance, compared with only 9 percent of non poor persons who were uninsured. Another measure of access is a regular source of care, the "place where a person goes for health care when sick." In 1980, 15 percent of people younger than 65 who were covered by Medicaid had no regular source of care. This is similar to the rate for the privately insured. However, the types of providers that were cited as the regular source of care differed. Medicaid recipients were more likely to have hospital outpatient departments and emergency rooms as a regular source.About one-fourth of the uninsured had no regular source of care.The third measure of access presented is physician-visit rates adjusted for health status.Again, Medicaid-covered persons resembled the privately insured, while the uninsured had much lower visit rates, after adjusting for their relatively good health status.Within the Medicaid Program, there are differences between States and eligibility groups in rates of physician visits after adjusting for health status.For example, Texas, the most restrictive of the State Medicaid Programs among the four States surveyed, had substantially lower rates, and those differences were most marked for those covered under the Aid for Dependent Children program population.An examination of trends in measures of access to care during the 1970s suggests that there was little change in access to care for the low-income population during the decade. It is not possible to examine the specific experience of the Medicaid population during the decade owing to a lack of data on that population for the earlier period.