• TABLE OF CONTENTS
HIDE
 Title Page
 Main
 Appendix






Title: Comparing satisfaction with care among MediPass and HMO enrollees in Florida Medicaid
CITATION PDF VIEWER THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00091300/00001
 Material Information
Title: Comparing satisfaction with care among MediPass and HMO enrollees in Florida Medicaid
Physical Description: Book
Language: English
Creator: Steingraber, Heather
Publisher: Florida Center for Medicaid & the Uninsured, College of Public Health and Health Professions, University of Florida
Place of Publication: Gainesville, Fla.
 Record Information
Bibliographic ID: UF00091300
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.

Downloads
Table of Contents
    Title Page
        Title Page
    Main
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
    Appendix
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
Full Text




Comparing Satisfaction with Care among MediPass and HMO
Enrollees in Florida Medicaid


Heather Steingraber, MAC (ABT)
Cameron Schiller, MS
Allyson Hall, PhD
Robert G Frank, PhD


Florida Center for Medicaid & the Uninsured
College of Health Professions
University of Florida
352/273-5059


Sponsored by
The Agency for Health Care Administration


June, 2003







Introduction


Purpose











Medicaid Managed
Care Organizations


This report presents an analysis of enrollee satisfaction with the Florida
Medicaid program. Demographics and program satisfaction are
reported for adult Medicaid enrollees, and are presented showing
results for respondents overall, as well as by the type of Managed Care
Organization (MCO) of the respondent. For those enrolled in the
MediPass program, data are also presented broken down by whether
the respondents resided in a county with offers HMOs or in a county
which offers only MediPass.

The purpose of this report is to examine the demographic
characteristics of MediPass enrollees, as compared with the
characteristics of HMO enrollees, and to assess the relative satisfaction
of these two groups in comparison with one another. Furthermore, we
explore the characteristics of MediPass enrollees who reside in counties
which offer one or more HMOs, compared with those who reside in
counties which do not offer HMOs. Finally, a discussion of differences in
the mode of survey administration is included in order to provide
guidance to future Medicaid researchers regarding appropriate
methodology for the Florida Medicaid population.

The Agency for Health Care Administration (AHCA) has contracted
with various Managed Care Organizations (MCOs) to oversee the
health care of Medicaid enrollees. Two types of MCOs are currently
available for adults in the Florida Medicaid program:' Health
Maintenance Organizations (HMOs), and the Medicaid Provider
Access System, called "MediPass," which is a Primary Care Case
Management System. The HMOs and the MediPass program offer
benefits packages that are substantially similar, though the HMOs may
offer special services such as transportation to medical appointments,
and over-the-counter drug reimbursement, in addition. The two types
of MCOs differ in how they manage the care of their enrollees and in
how they manage the providers in their network. Further information on
the differences between MCOs can be found in the Florida Medicaid
Summary of Services.

As of June 2003, Medicaid HMOs were available in 34 of the 67 Florida
counties, with 23 counties offering two or more HMOs to their enrollees
(see Appendix A). All counties offer the MediPass program. Upon
enrollment, those who reside in counties without HMOs are
automatically enrolled in MediPass, while those who reside in counties
with HMOs must choose from MediPass and the HMO(s) offered in their
county. If an enrollee fails to indicate his or her choice to Medicaid
within 30 days of the date Medicaid eligibility began, he or she is
assigned to one of the MCOs by AHCA.


Page1











Medicaid Managed Care





MediPass PSN
dents of Available to R
Counties Available to Residents of Broward and v
ic HMOs All 67 Florida Counties Count
unty





In the 34 "Choice" In the 33 "non-Choice"
Counties, MediPass Counties, Enrollees Had No
Enrollees Had a Choice MCO Option but MediPass
of MediPass or an HMO


Figure 1. Medicaid Managed Care Organizations


HMOs
Available to Resi
the 34 "Choice"
Choice of Specif
Varies by Co


residents of
4iami-Dade
ies


Page 2


I I







Methodology

In order to gather demographic information from HMO and MediPass
recipients, and to assess relative satisfaction with the different MCOs,
program enrollees were contacted by telephone and mail and asked
to complete a short questionnaire. The Consumer Assessment of
Health Plans Survey (CAHPS) version 2.0 was administered to those
who consented to participate. The CAHPS is a standardized survey
instrument, used widely in the health care industry to assess enrollee
satisfaction with health plans. Demographic questions are also
included as part of the CAHPS.


Sampling Concurrent, random samples were drawn from among HMO
enrollees and MediPass enrollees. The HMO sample was chosen as
part of AHCA's HMO Report Card project, and the survey results for
that project were used for comparison with the MediPass surveys
conducted for this project. Information concerning the sampling
procedures or response rates for the HMO surveys can be found in the
Florida HMO Report 2003.

The MediPass sample was drawn from among program enrollees who
had been continuously enrolled in MediPass for 6 or more months.
The sample was stratified according to whether the enrollees resided
in a county which offered HMOs or in a county which did not offer
HMOs. These strata were then treated as separate samples. Survey
dispositions and completed interviews were tracked separately for
each sample.

For all surveys, samples of eligible respondents were provided by the
Agency. For those respondents whose AHCA record did not include
a telephone number, the Department of Children and Families was
contacted to provide telephone numbers from their database. A
commercial firm was also contracted to provide contact information
for subjects who could not be located through other means.


Survey Administration The Survey Research Center at the University of Florida's Bureau of
Economic and Business Research (BEBR) conducted surveys in the
Spring of 2003. A mixed mode of administration was employed to
reach respondents, with both telephone and mail contacts being
attempted.

Initial contact with potential respondents was in the form of a letter
mailed to survey subjects, informing them that they had been
selected to take part in the survey. Approximately 10 days following
the mailing, telephone surveying began. Subjects who could not be
reached by telephone after several attempts were sent a paper-and-
pencil version of the questionnaire by mail, and were provided with a
pre-addressed, stamped envelope in which to return the survey.
Approximately one month later, another such mailout was sent to
those who had not responded by mail and still could not be reached
by phone.
Page 3







The quality of the contact information for enrollees was poor, with
64.1% of the sample having no telephone number on file with AHCA.
Many measures were taken to find valid contact information for
respondents. Following all of these steps, and the removal of duplicate
records, only 38.9% (N=2,694 of 6,927) of the sample remained valid;
that is, they had a 10-digit phone number and were not a duplicate
record. Subjects were contacted up to 15 times by phone and twice
by mail in an attempt to secure cooperation or obtain updated
contact information. Despite these attempts, a large number of
respondents proved to be unreachable.


Outcome Rates An important aspect in determining whether survey results are truly
representative of the population in question is to determine whether
"non-response effects" exist. Non-response effects occur when non
respondents from the original sample differ from those who did respond
in significant ways which might affect results of the study. One
important step in determining whether non-response effects exist is to
calculate outcome rates.

The American Association for Public Opinion Research (AAPOR)
recognizes the use of a number of different types of outcome rates,
and a number of different methods for calculating each of those
types2. One type of outcome rate is the Response Rate, which takes
into account the number of interviews in proportion to the number of
eligible respondents. Numerous methods exist to calculate Response
Rates, with major differences being in the way in which the number of
eligibles is determined and the way partial interviews are allocated.
Another type of outcome rate is the Cooperation Rate, which takes
into consideration the number of interviews in proportion to all eligibles
ever contacted. Cooperation Rates exclude from calculation those
respondents who could not be located. Like Response Rates, there are
numerous ways to calculate Cooperation Rates, with the major
differences being in the way that the number of eligibles is determined
and the way partial interviews are allocated. Researchers consider
various criteria in determining which outcome method to use, with the
quality of the sample being a major criterion in their decision.

Table 1 below shows response rates and cooperation rates for the HMO
surveys and the MediPass surveys that were conducted by telephone.
Four different AAPOR-approved outcome measures are given.
Response Rate (RR) 1 is the most stringent method given, and RR6 is the
least restrictive of the response rate methods. Cooperation Rate
(COOP) 1 is less stringent than either RR method, and COOP4 is the
least stringent of all methods presented. The outcome rates ranged
from a high of 92% to a low of 33%, depending on the sample and the
method of calculation. Overall, the HMO surveys had a response rate
of 48-57%, while the MediPass rates ranged from 58-71%. The rate of
refusals was low for all populations surveyed. Using AAPOR's Refusal
Rate 1 formula, the rates were calculated at between 5-17% (see Table
1).
2 The American Association for Public Opinion Research. 2000. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates
for Surveys. Ann Arbor, Michigan: AAPOR Page 4
Page 4








Table 1. Outcome Rates
Number of Valid More Stringent -> Less Stringent
Sample Name Completed Sample Resp. Resp. Coop. Coop. Refusal
Interviews Rate 1 Rate 6 Rate 1 Rate 4 Rate 1
HMO overall 4,811 17,690 48.2% 56.9% 67.3% 80.2% 11.9%
AvMed 274 2281 33.2% 44.8% 63.0% 73.3% 12.1%
Beacon 76 455 38.8% 46.1% 55.1% 69.7% 16.8%
DHP 158 644 55.2% 64.5% 75.2% 85.1% 9.8%
Foundation 157 604 47.9% 54.1% 59.7% 79.4% 12.5%
Healthease 238 854 58.9% 66.9% 76.0% 87.5% 8.4%
Healthy Palm Beaches 22 100 53.7% 78.6% 91.7% 91.7% 4.9%
JMH 232 820 58.6% 66.0% 72.0% 85.7% 9.8%
Neighborhood 181 813 42.1% 50.7% 59.0% 75.4% 13.7%
PCA 239 1123 44.8% 52.1% 60.4% 73.2% 16.5%
Physicians 228 824 58.0% 65.9% 73.3% 86.0% 9.4%
Preferred 168 798 46.3% 55.4% 67.2% 79.2% 12.1%
Staywell 234 952 56.9% 65.0% 75.7% 85.1% 10.0%
United 234 958 50.6% 56.5% 66.9% 79.9% 12.8%
MediPass in HMO counties 372 1,244 61.6% 70.8% 78.3% 85.7% 10.3%
MediPass in non HMO counties 377 1,450 57.6% 66.7% 77.1% 87.3% 8.4%


Data Analysis and
Weighting


Report Organization


The HMO and MediPass samples were analyzed concurrently using SAS
and SPSS. Descriptive statistics were calculated for both samples and
selected results are discussed in this report. All statistics are reported in
Appendix B.

The survey data set for the HMO respondents was weighted to reflect
the actual distribution of individual HMO enrollment in Florida Medicaid.
The reports of each HMO's respondents were weighted according to
the actual market share that particular HMO occupied within the
Medicaid program as of December, 2001. The weights were applied in
order to properly reflect the relative sizes of each HMO; companies
with large enrollments should have a larger "impact" on results than
those with smaller enrollments. Appendix B shows the actual enrollment
for each Medicaid HMO, which were used to calculate the weights.

The MediPass data were weighted according to the actual proportion
of enrollees who reside in counties which offer a choice between
MediPass and HMO, and those counties which do not offer choice.
These enrollment figures and corresponding weights can also be found
in Appendix B.

The overall Medicaid figures that are reported are also weighted,
according to the overall proportion that each group (each of the
HMOs, MediPass enrollees in counties with HMOs, and MediPass
enrollees in counties without HMOs) represents in the Medicaid
population.


As mentioned previously, results for each item in the CAHPS survey can
be found in Appendix B. Selected results are also discussed in the body
of this report. First, the ratings of HMO enrollees and MediPass enrollees
who live in choice counties are compared, and significant differences


Page 5







are explored. Next, ratings of MediPass enrollees are explored in-
depth, and comparisons are made between the reports of those
residing in counties with HMOs and those residing in counties with
MediPass only. In a subsequent section, the characteristics of
subjects who responded by phone are compared with those who
responded by mail. Finally, recommendations are given for future
research.


Page 6







HMO vs. MediPass

The demographic characteristics and satisfaction ratings of enrollees in
the two Medicaid MCOs are compared, below. These ratings are
taken only from subjects residing in those counties which offer both
MCO options. A list of these counties can be found in the Appendix.
The ratings of those who reside in MediPass-only counties are explored
in the next section of this report. Because MCO choice is not offered to
those residing in MediPass-only counties, those respondents cannot be
included in the ratings of the MCOs. The demographic and
geographic makeup of non-choice counties differs significantly from
choice counties. Non-choice counties tend to be more rural and have
more widely dispersed populations. Provider networks are less
extensive and thus, enrollees have more difficulty accessing care.
These factors are likely to affect the ratings of survey respondents,
though the effect may be due to physical attributes of the county, and
not the attributes of the Medicaid MCO operating there.

Demographics The demographic characteristics of the HMO respondents and
Medicaid respondents are discussed below.

Gender For both the HMO and the MediPass group, the majority of respondents
were female. Seventy-nine percent of respondents from the HMO
group were female, and 77% from the MediPass group were female.
There was no significant difference between the makeup of the HMO
and MediPass groups in terms of gender.

Age The adults in both survey samples were widely distributed in terms of
age. However, the HMO group was made of larger percentages of the
youngest and oldest groups, compared with the MediPass group.
This difference in ages was statistically significant at the p<0.0001 level.

Table 2. Age of HMO vs. MediPass Enrollees


Age HMO MediPass
18-24 years 16.7% 6.3%
25-34 years 21.3% 22.6%
35-44 years 18.5% 27.0%
45-54 years 15.7% 24.0%
55-64 years 15.7% 16.8%
35+ years 12.0% 3.3%


Race For both the HMO and MediPass samples, the majority of respondents
were white, though in the HMO group, the percentage of whites was
significantly smaller than in the MediPass group (see Figure 2). Fifty-one
percent of HMO enrollees were white, compared with 67% of MediPass
enrollees. This difference was statistically significant at the p<0.002
level. The percentage of blacks in the samples was also significantly
different, with the HMO group being made up of a significantly larger
percentage of blacks than the MediPass group (39% and 26%,
respectively, p<0.006).

Page 7






Figure 2. Racial Makeup of HMO vs. MediPass Respondents


80%
70% 66.9%
60% -
60% 50.5%
50%
40% -
30% 25.8%
20%
10% 3.6% 4.4%
10%
0%
Whites Blacks Other

SHMO EMediPass


A statistically significant difference was found between the ethnic
characteristics of HMO enrollees and MediPass enrollees, with the
HMO group being made up of a significantly larger portion of
Hispanics than the MediPass group. Nearly 24% of the HMO enrollees
surveyed reported that they were Hispanic, while 9% of MediPass
enrollees were Hispanic. This difference was statistically significant at
the p<0.001 level. (See Figure 3.)


Figure 3. Hispanic Ethnicity in HMO vs. MediPass


MediPass

7.5%


SHispanic Non Hispanic236%
76.4%.


[ Hispanic U Non Hispanic


I Hispanic Non Hispanic


92.5%


Education





Health Status


The HMO and MediPass groups did not differ significantly in terms of
education levels. For both groups, roughly 40% of respondents had
less than a high school degree, while 37-38% had a high school
diploma or GED, and the remaining 21-24% reported having
education beyond high school.

The HMO and MediPass group did not differ significantly in terms of
their self-reported health status. For both samples, roughly 25% of
respondents reported being in "excellent" or "very good" health, 25%
reported being in "good" health, and the remaining 50% (roughly)
reported being in "fair" or "poor" health. Although the differences


Page 8


Ethnicity


HMO







between the groups was not significant, it is interesting to note that
16% of the MediPass group was in "poor" health, while 25% of the
MediPass group was in "poor" health.


Satisfaction




Continuity of Care


Specialty Care &
Referrals


Overall, Medicaid enrollees are very satisfied with the quality of
care they receive, regardless of whether they are enrolled in an
HMO or in MediPass. Selected measures of satisfaction and quality
of care from the CAHPS 2.0 are discussed below.

The term "Continuity of Care" refers to the extent to which enrollees
are able to see a single health care provider over a period of time.
Measuring the continuity of care that enrollees receive is an
important step in describing the overall quality of care provided by
a health insurance program like Medicaid. To this end, subjects
were asked whether they had continued to see the same health
care provider while on Medicaid as they had seen before enrolling,
and whether they had switched providers since then. For both the
HMO and MediPass groups, roughly 55% of respondents reported
having changed doctors while enrolled in Medicaid.

Among those who had changed primary care providers while
enrolled, more than two-thirds reported that it was "not a problem"
to find a satisfactory PCP while on the program, while 8-15%
reported it was "a small problem" and roughly 20% reported it was
"a big problem." The reports of the HMO and MediPass groups did
not differ significantly.

Approximately three-fourths of the Medicaid enrollees surveyed
reported having a primary care provider (called a "personal doctor
or nurse" in the CAHPS) at the time of interview. Those who had a
primary care provider were asked to rate this provider on a scale of
0 to 10, with 0 being the "worst personal doctor or nurse possible,"
and 10 being the "best personal doctor or nurse possible." HMO
enrollees rated their PCP at 8.41 2.194, while MediPass enrollees
rated at 8.46 1.990. There was no significant difference between
these ratings.


Approximately 47% of Medicaid enrollees surveyed reported that
they had needed to see a specialist physician at some time in the 6
months prior to survey. Roughly 63% of those who needed to see a
specialist reported that it was "not a problem" to get a referral for
this care, while 13% reported it was "a small problem."
Approximately 24% of respondents indicated that it was "a big
problem" to get a referral. Roughly 41% of respondents reported
actually having seen a specialist in the 6 months prior to interview.
There were no differences between the HMO and MediPass groups
on these measures.

Clearly, the majority of Medicaid enrollees did not experience
problems obtaining referrals for specialty care. However, a
significant minority nearly a quarter of respondents found it to be
very problematic. While this finding is troubling, it is important that
Page 9







the reader note the exact wording of the CAHPS question:


Calling Providers' Offices










Appointments for Routine
Care







Appointments for Acute
Care


Q: In the last 6 months, did you or a doctor think you needed
to see a specialist?"

The survey question does not differentiate between people who had
a justified medical need for specialty care and those who did simply
thought that they did. Thus, it is possible that a significant portion of
those who reported having major difficulties getting a referral may be
the people who felt they needed to see a specialist, but their PCP did
not agree. In these cases, it could be that the enrollee did not need
the speciality care, though he or she believed s/he did, or it could be
that the PCP did not provide a referral that was, indeed, justified.
Further analysis using claims data could help to determine which of
these possibilities is more likely in these cases.

When asked to rate their specialist on a scale from 0 to 10, the ratings
of the HMO and MediPass group were very similar. HMO enrollees
rated their specialists at 8.50 2.169 and MediPass enrollees rated
specialists at 8.34 2.374. There were no significant differences
between the ratings of the two groups.

Roughly half (49-55%) of Medicaid enrollees reported that they had
called their PCP's office to get help or advice during the 6 months
prior to interview. This figure did not vary significantly between HMO
enrollees and MediPass enrollees. When asked whether they
received the help or advice needed as a result of this call, 70% of
respondents in both groups reported that they "usually" or "always"
received the help needed, while 30% reported that they "sometimes"
or "never" got that help. HMO and MediPass enrollees reported
similarly.

Approximately two-thirds of Medicaid enrollees reported that they
had made an appointment for regular or routine health care in the 6
months prior to interview, and 77-78% of those enrollees reported that
they "always" or "usually" got the appointment as soon as they
wanted. There was no statistically significant difference between the
reports of the HMO enrollees versus the MediPass enrollees on this
measure.

The HMO and MediPass groups differed significantly when asked
whether they had experienced an illness or injury needing immediate
care in the 6 months prior to interview. Forty-one percent of HMO
enrollees reported having needed immediate care, while 52% of
MediPass enrollees did. This difference between groups was
statistically significant, with p<0.049. Those who had an illness or injury
needing immediate care were asked whether they had gotten that
care as soon as they wanted. Seventy-five to eighty percent of
respondents reported that they "usually" or "always" got this care as
soon as needed, while 16-19% reported "sometimes" getting the care
as soon as needed, and 5-6% "never" got it. These figures were
similar for HMO and MediPass enrollees.


Page 10






Overall Medical Care &
Visits


Wait Times in Doctor's
Offices








Providers' Office Staff





Interacting with Providers


Medicaid enrollees were asked about the number of visits they had
made to any doctor's office or clinic in the 6 months prior to
interview. Roughly eighteen percent of respondents reported
having made no visits, while 29% reported having made 1 or 2 visits,
and 19% reported 3 or 4 visits. Almost 34% of respondents reported
having made 5 or more health care visits in the 6 months prior to
interview.

Most respondents (73%) reported it was "not a problem" to get
necessary care, while 16-17% had "a small problem" and 10-11%
had "a big problem." No significant differences were found
between the HMO and MediPass groups. When asked whether
they had experienced problems with delays in health care while
awaiting approval for treatment from Medicaid, 70% of HMO
enrollees and 80% of MediPass enrollees reported that this was "not
a problem." Sixteen percent of HMO enrollees reported that it was
"a small problem," while 9% of MediPass reported thus. Fourteen
percent of HMO enrollees and 11% of MediPass enrollees indicated
that delays were "a big problem." No significant differences were
found between the HMO group and the MediPass group on any of
these measures.

Roughly a quarter of Medicaid enrollees (26%) reported that they
"always" waited more than 15 minutes past their appointment time
to see their provider. Thirteen percent indicated that they "usually"
experienced-long wait times, and 41% "sometimes" did. Twenty
percent of respondents "never" had to wait more than 15 minutes
past their appointment time to see their provider. There were no
differences between the responses of HMO and Medipass enrollees
surveyed.

The vast majority of respondents (89%) indicated that the office staff
in their providers' offices were "usually" or "always" courteous and
respectful, and 82% of respondents reported that staff were
"usually" or "always" helpful. The reports of the HMO and MediPass
groups were virtually identical on these measures.

Medicaid enrollees indicated that they had little trouble
communicating with their health care providers (see Table 3).
Eighty-three percent of Medicaid enrollees overall indicated that
they felt that their PCP listened carefully to them, and 86% reported
that their provider showed respect for them. Eighty-three percent
indicated that their provider explained things to them in a way they
could understand and seventy-nine percent reported that their
doctor spent enough time with them. Ninety-one percent of
respondents reported that they did not generally have problems
communication with their providers due to language differences.
There were no statistically significant differences in the reports of
HMO and MediPass enrollees on these measures.

When asked to rate all of their health care on a scale of 0 to 10,
Medicaid enrollees overall rated their care very highly. The HMO
group rated their care at 8.29 2.124, while the MediPass group


Page 11







Table 3. Interaction with Providers
HMO MediPass
Provider Listened Carefully to Patient
Always or Usually 83.7% 83.3%
Sometimes or Never 16.3% 16.7%
Difficulty Communicating with Provider Due to Language Barriers
Always or Usually 8.5% 9.7%
Sometimes or Never 91.5% 90.3%
Provider Explained Things So Patient Could Understand
Always or Usually 82.7% 82.5%
Sometimes or Never 17.2% 17.5%
Provider Showed Respect for What Patient Said
Always or Usually 84.4% 86.3%
Sometimes or Never 15.6% 13.7%
Doctor Spent Enough Time With Patient
Always or Usually 76.8% 79.8%
Sometimes or Never 23.2% 20.2%


rated their care at 8.21 2.230. There was no significant difference
between the ratings of the two groups.

The vast majority of Medicaid enrollees surveyed, (94%) indicated
that they did not need an interpreter to help them communicate
with their doctor or other health provider. Among those who did
need an interpreter, half (50%) indicated that they "usually" or
"always" got that help when needed. There were no differences in
the reports of HMO and MediPass enrollees on these measures.

Significant differences were found in the reports of the two groups
regarding information received from the plan upon enrollment (see
Figure 4). Sixty-two percent of Medicaid enrollees overall indicated
that they received information about their program when they
enrolled. Seventy-four percent of HMO enrollees reported having
received information, compared with 58% of MediPass enrollees.
This difference was statistically significant, with p<0.007. Among

Figure 4. Received Information Upon Enrollment


Page 12


MediPass


25.6%


42.50/


57.5%


74.4%


* Received Information
* Did Not Receive Information


HMO






those who did receive information from their plan upon
enrollment, 92% indicated that "all" or "most" of the information
was correct. There was no statistical difference between the
HMO and MediPass groups on this measure.

Most enrollees (75%) reported that they did not look for any
written materials from their program. Large differences were
found on this measure between HMO and MediPass enrollees,
with more HMO enrollees reporting that they looked for the
materials than MediPass enrollees. Thirty-seven percent of HMO
enrollees reported that they looked for written materials from the
program, while 22% of MediPass enrollees looked for materials.
This difference is statistically significant, with p<0.002. Those who
did look for written information largely reported that they had no
problems finding or understanding the materials.

Figure 5. Sought Written Information from Program


Customer Service














Paperwork


When asked whether they had called the program's customer
service department, 47% of HMO enrollees reported
affirmatively, while 24% of MediPass enrollees reported that they
had called (see Figure 6). This difference was statistically
significant at the p<0.001 level. There was, however, no
difference between the programs in terms of the quality of the
customer service help received. Fifty-eight percent of
respondents overall indicated that it was "not a problem" to get
the help that was needed, while 24% indicated it was "a small
problem." Eighteen percent of respondents overall indicated
that it was "a big problem" to get needed help via telephone
from their program's customer service department.

Most enrollees reported that they had not had experience with
doing paperwork for their program. Of the 18% who had
experience with paperwork, most reported that this paperwork
was "not a problem."

When asked for their overall rating of their health plan, both
HMO and MediPass enrollees rated their plans highly. The mean
rating among HMO enrollees was 8.02 2.402, while MediPass
enrollees rated their plan at 7.79 2.577. There was no
significant difference in the ratings of the two groups.


Page 13


MediPass


22.0%


37.0%


63.0%


78.0%


* Looked for Written Information
* Did Not Look for Written Information


HMO










Figure 6. Called Customer Service


Page 14


MediPass


23.7%


47.2%


76.3%


* Called Customer Service
* Did Not Call Customer Service


HMO







MediPass: Counties With HMOs vs. Counties Without HMOs
The demographic characteristics and satisfaction ratings of
enrollees in the MediPass program overall were explored in the
previous section. In this section, the characteristics and ratings
of MediPass enrollees residing in choice counties are
compared with those of MediPass enrollees residing in non-
choice counties, and significant differences between the two
groups are discussed.


Demographics


Satisfaction


The demographic characteristics of enrollees in counties which
offer Medicaid HMOs did not vary significantly from counties
which did not offer HMOs in terms of health status, age,
gender, education level, or ethnicity. They did vary, however,
in terms of race, with a smaller percentage of the HMO county
group being White and a larger percentage being Black than
is found among non HMO county group (see Figure 7). Fifty-
seven percent of the HMO county group was White, while 67%
of the non-HMO county group was White, with the difference
being statistically significant at the p<.007 level. Thirty-seven
percent of the HMO county group was Black, compared with
26% of the non HMO county arouo (D<0.001).

Figure 7. Race of Medicaid Enrollees Residing in HMO
Counties and non-HMO Counties


80%
70% 66.9%
60% 57.4%
50%
40% 37.0%
40% -2.
30%
20%
10% _3.7% 4.1%
0%
Whites Blacks Other

HMO Counties U MediPass Only Counties



For the vast majority of questionnaire items relating to
satisfaction, the reports of MediPass enrollees living in HMO
counties did not differ significantly from those of enrollees
living in non-HMO counties. Exceptions are discussed below.


Residents of HMO counties had significantly fewer problems
finding a primary care provider compared with residents of


Page 15






non HMO counties (p<0.037). Sixteen percent of the HMO
county group reported having had "a big problem" finding a
primary care physician that they were "happy with,"
compared with 24% of the non HMO county group (see Figure
8). This finding is not particularly surprising, considering that non
HMO counties tend to have smaller populations which are
more dispersed, thus resulting in provider networks that are less
extensive and a health system that is harder to access.

Figure 8. Difficulty Finding a Primary Care Provider

HMO MediPass
Counties Only
Counties
16.2% 24.3%

16.9%
8.3%
66.9% W 67.4%



SNo Problem Small Problem O Big Problem


Residents of HMO counties reported having significantly less
difficulty with language and communication barriers with their
providers (p<0.017). Residents of HMO counties reported
"usually" or "always" having trouble 7% of the time, while
residents of non HMO counties reported having trouble 9% of
the time. However, this difference, while statistically significant,
is so small as to be of little practical value.

Residents of HMO counties and non HMO counties did not
differ significantly on any of the CAHPS 10-point scales
measuring overall satisfaction.


Page 16







Phone vs. Mail

The demographic characteristics and satisfaction ratings of
the MediPass respondents who were surveyed by phone
are compared below with those who responded by mail.
A total of 943 completed interviews are included in this
analysis, with 748 administered by phone and 195 by mail.


Demographics















Satisfaction




Continuity of Care and PCPs












Called their PCP for help or
advice





Got an appointment for routine
care in a timely manner


Among both samples, the majority of respondents were
female (77%), white (63%) and non-Hispanic (92%). In terms
of age, respondents were rather evenly distributed
between the ages of 25-64 years, with less than 10% total
being in the older or younger age categories. Forty-three
percent of respondents had less than a high school
diploma, 37% had a high school diploma or its equivalent
and 21% had education beyond high school. The majority
of respondents (56%) described themselves as being in fair
or poor health, while 24% were in "good" health and 20%
were in "very good" or "excellent" health. There were no
significant differences in the demographic characteristics
of the phone and mail samples.


On most measures of satisfaction and access, the mail and
telephone groups reported similarly. However, statistically
significant differences were found on 10 of the CAHPS
measures.

Mail respondents reported having received a new PCP
more often than telephone respondents. Fifty-two percent
of mail respondents changed PCPs, while 40% of telephone
respondents changed. This difference was highly
statistically significant, with p<0.003. Respondents who did
receive a new PCP were asked whether they had difficulty
finding a new provider that they liked. Compared with the
telephone respondents, a significantly larger portion of the
mail respondents reported having some degree of difficulty
finding a provider they liked, though fewer reported having
major difficulties. (p<0.016)

Sixty-five percent of subjects who responded by mail
indicated that they had called a doctor's office for help or
advice in the 6 months prior to interview. This compares
with 53% of telephone respondents. The difference
between the groups is statistically significant at the p<0.003
level.

Significant differences were also found between the two
groups on the following measures:

Got an appointment for routine care in a timely


Page 17







manner,
Number of medical visits,
Helpfulness of staff at PCP's office,
PCP showed respect for patient's opinions,
PCP spent enough time with patient,
Medicaid is used for all or most of health care, and
Received information about program when
enrolled.

The differences between the groups on these measures,
while statistically significant, were of little practical value.
The interested reader can refer to Appendix B for item-by-
item results and chi-square statistics.


Page 18







Summary and Recommendations


Comparing HMOs vs.
MediPass


Comparing MediPass
Enrollees in HMO Counties vs.
Enrollees in MediPass-only
Counties


Comparing Modes of Survey
Administration: Phone vs.
Mail


Enrollees in Medicaid HMOs and those in the MediPass Program
were similar in terms of in terms of gender, health status, and
education level. The groups differed, however, in terms of age,
ethnicity, and race. The HMO group was made up of a larger
portion of the youngest (18-24 years old) and oldest (65+ years)
enrollees, as compared to the MediPass group. The HMO group
was also composed of more Hispanics and more Blacks, and
fewer Whites than the MediPass group.

Overall, Medicaid enrollees are satisfied with the quality of care
they receive, and, for most measures of access and satisfaction,
the two MCO groups reported similarly. A significant difference
was found regarding the need for acute care. As compared
with MediPass enrollees, fewer HMO enrollees reported having
had a need for acute care in the 6 months prior to interview.
Differences were also found between the MCO groups on
measures of information-seeking behavior and interaction with
plan administration. A larger portion of HMO enrollees reported
having received information from their plan upon enrollment,
and having sought written information from their plan, as
compared with MediPass enrollees. Also, a larger portion of
HMO enrollees than MediPass enrollees reported having called
their plan's customer service department.

In terms of gender, ethnicity, age, health status, and education
level, there is no statistically significant difference between
MediPass enrollees living in counties with HMOs and those living
in counties without HMOs. However, a difference was found in
the racial makeup of the groups, with the enrollees from HMO
counties being made up of a smaller percentage of Whites, and
a larger percentage of Blacks as compared with the group of
enrollees from non-HMO counties. This difference may be due to
geographic factors, however, since counties that offer HMOs
tend to be more urban and more racially diverse than those
which do not offer HMOs.

By and large, satisfaction did not differ significantly between the
HMO counties and non-HMO counties, except that residents of
HMO counties reported having fewer problems getting a
satisfactory doctor or nurse, compared with residents of non
HMO counties. Again, this finding may be due to the more
limited provider networks available in the non HMO counties-

Few differences were found between the group of respondents
who completed the survey by telephone and those who
completed by mail. The demographic characteristics of the
group were not statistically different. Meaningful differences
between the groups were found on only 3 of the 38 satisfaction
and access measures from the survey. Mail respondents more
often reported having received a new doctor or nurse, and


Page 19







having had a "small problem" getting a satisfactory doctor
or nurse, as compared with telephone respondents. It is
possible that these differences reflect a higher likelihood that
the mail respondents may have recently moved. US Mail is
forwarded for a period of months following a relocation,
while telephone numbers may not be forwarded. Thus, mail
surveys may reach respondents not reachable by telephone.
Another possibility, however, is that the difference, while
statistically significant, is due to an external factor, or due to
chance. Further studies are needed to determine if this
difference is stable over time, and to test the possibility that
the mail respondents may have relocated recently.

A significant difference was also found between the
telephone and mail groups on the measure of telephone
conversations with doctor's offices. As compared with the
telephone group, the mail group was significantly more likely
to report having called a doctor's office in the 6 months prior
to interview. This difference may also be due to recent
relocation on the part of the mail respondents. When faced
with the need to refill medication or get basic medical
advice, patients who have recently moved may be more
likely to call their "old" primary care provider than establish a
new relationship with a PCP in their new area. Another
possibility is that patients in more rural areas may be more
likely to phone their provider, rather than driving many miles
for an office visit. Further research is needed to determine if
either of these possibilities may be likely.

Another consideration regarding differences in the two
survey groups is the difference in respondents' perceptions of
the telephone and mail surveys. Although the instruments
are identical in content, they may be perceived differently
since the format of one is visual and the other is aural. Highly
skewed results from some CAHPS items suggests this may be
the case. Further research is needed to determine possible
effects of the perceptual differences.


Page 20










Appendix A







HMO weights


Market Share
Plan Name Total of HMO
Enrolled Members

BEACON HEALTH PLAN 17,521 2.68%
DISCOVERY HEALTH PLAN 14,781 2.26%
FLORIDA 1ST HEALTH PLAN 3,433 0.52%
FOUNDATION HEALTH 8,899 1.36%
HEALTHEASE 160,283 24.51%
HUMANA FAMILY 52,939 8.09%
JMH HEALTH PLAN 9,755 1.49%
NEIGHBORHOOD HEALTH 15,639 2.39%
HEALTHY PALM BEACHES 5,598 0.86%
PHYSICIAN CARE PLAN 128,067 19.58%
PREFERRED MEDICAL PLAN 11,728 1.79%
ST. AUGUSTINE HEALTH CARE 28,448 4.35%
STAYWELL 162,187 24.80%
UNITED HEALTHCARE PLAN 31,680 4.84%
UNITED ELDERCARE 3,102 0.47%

TOTAL 654,060 100.00%







MediPass weights


enrollment % of total
Total Enrollment in Counties with HMOs 494707 76.35%
Total Enrollment in Counties without HMOs 153238 23.65%
Total 647945 100.00%







Overall weights


Enrollment Percentage

BEACON HEALTH PLAN 17,521 1.35%
DISCOVERY HEALTH PLAN 14,781 1.14%
FLORIDA 1ST HEALTH PLAN 3,433 0.26%
FOUNDATION HEALTH 8,899 0.68%
HEALTHEASE 160,283 12.31%
HUMANA FAMILY 52,939 4.07%
JMH HEALTH PLAN 9,755 0.75%
NEIGHBORHOOD HEALTH 15,639 1.20%
HEALTHY PALM BEACHES 5,598 0.43%
PHYSICIAN CARE PLAN 128,067 9.84%
PREFERRED MEDICAL PLAN 11,728 0.90%
ST. AUGUSTINE HEALTH CARE 28,448 2.18%
STAYWELL 162,187 12.46%
UNITED HEALTHCARE PLAN 31,680 2.43%
UNITED ELDERCARE 3,102 0.24%
MediPass enrollees in counties with HMOs 494707 38.00%
MediPass enrollees in counties without HMOs 153238 11.77%
Total 1,302,005 100.00%







MCO Choice by County


m- m-
zO ZO

r g r HMO County or
-o o0 #ofHMOs Non HMO county
ALACHUA 19262 0 0 Non HMO County
BAKER 1502 914 1 HMO County
BAY 13909 0 0 Non HMO County
BRADFORD 2667 0 0 Non HMO County
BREVARD 10903 17352 2 HMO County
BROWARD 39653 68057 9 HMO County
CALHOUN 1239 152 1 HMO County
CHARLOTTE 5114 0 0 Non HMO County
CITRUS 5334 2094 1 HMO County
CLAY 3200 2354 1 HMO County
COLLIER 10647 0 0 Non HMO County
COLUMBIA 7312 0 0 Non HMO County
DADE 127784 21409 12 HMO County
DESOTO 3026 0 0 Non HMO County
DIXIE 1812 0 0 Non HMO County
DUVAL 34892 33124 1 HMO County
ESCAMBIA 16647 14396 1 HMO County
FLAGLER 2060 0 0 Non HMO County
FRANKLIN 771 131 1 HMO County
GADSDEN 3227 3878 2 HMO County
GILCHRIST 1884 0 0 Non HMO County
GLADES 56 0 0 Non HMO County
GULF 1190 0 0 Non HMO County
HAMILTON 1677 0 0 Non HMO County
HARDEE 4041 0 0 Non HMO County
HENDRY 3775 766 1 HMO County
HERNANDO 3560 5394 1 HMO County
HIGHLANDS 4595 3122 2 HMO County
HILLSBOROUGH 28418 66491 4 HMO County
HOLMES 2437 0 0 Non HMO County
INDIAN RIVER 5471 0 0 Non HMO County
JACKSON 4257 0 0 Non HMO County
JEFFERSON 721 982 2 HMO County
LAFAYETTE 694 0 0 Non HMO County
LAKE 5995 8626 2 HMOCounty
LEE 12371 19748 3 HMO County
LEON 8282 8027 2 HMO County
LEVY 3196 0 0 Non HMO County
LIBERTY 427 181 2 HMO County
MADISON 1362 1070 2 HMO County
MANATEE 4634 12402 3 HMO County
MARION 15714 5859 1 HMO County
MARTIN 4799 880 1 HMO County
MONROE 3526 117421 0 Non HMO County
NASSAU 2203 0 0 Non HMO County
OKALOOSA 9188 0 0 Non HMO County
OKEECHOBEE 3741 0 0 Non HMO County
ORANGE 33091 53514 4 HMO County
OSCEOLA 4486 14306 4 HMO County
PALM BEACH 28520 39216 7 HMO County
PASCO 10205 15762 4 HMO County
PINELLAS 25207 35731 4 HMO County
POLK 11662 40008 5 HMO County
PUTNAM 7252 2254 1 HMO County
SANTA ROSA 5248 2856 1 HMO County
SARASOTA 3892 8017 3 HMO County
SEMINOLE 4092 11828 4 HMO County
STJOHNS 4612 0 0 Non HMO County
ST LUCIE 17818 0 0 Non HMO County







MCO Choice by County


m- m-


mr m HMO County or
-o -u o #ofHMOs Non HMO county
SUMTER 8535 0 0 Non HMO County
SUWANNEE 3418 0 0 Non HMO County
TAYLOR 2360 0 0 Non HMO County
UNION 1183 0 0 Non HMO County
VOLUSIA 20248 14746 2 HMO County
WAKULLA 999 992 2 HMO County
WALTON 3575 0 0 Non HMO County
WASHINGTON 2367 0 0 Non HMO County
STATE TOTAL: 647945 654060_










Appendix B







Demographic Characteristics of Survey Respondents in Counties with HMOs: HMO vs. MediPass


MediPass Enrollees in
diPs Enr in HMO Enrollees Tests of Significance
Counties with HMOs

N % or s N % or s I 2 ort P
Self-Assessed Overall Health
Excellent 33 9.0% 12 11.2%
Very Good 44 12.0% 19 17.8%
Good 79 21.5% 28 26.2% 6.542 0.162
Fair 120 32.7% 31 29.0%
Poor 91 24.8% 17 15.9%

Age
18-24 years 23 6.3% 18 16.7%
25-34 years 82 22.6% 23 21.3%
35-44 years 98 27.0% 20 18.5%
<0.001
45-54 years 87 24.0% 17 15.7%
55-64 years 61 16.8% 17 15.7%
65+ years 12 3.3% 13 12.0%

Sex
Male 85 22.8% 23 21.1%
0.148 0.700
Female 287 77.2% 86 78.9%

Highest School Grade Completed
8th Grade or Less 46 12.5% 12 11.2%
Some High School, but Didn't Graduate 107 29.2% 28 26.2%
High School Graduate, or GED 136 37.1% 41 38.3%
1.099 0.954
Some College or 65 17.7% 21 19.6%
2-Year College Degree 9 2.5% 4 3.7%
4-Year College Degree or More 4 1.1% 1 0.9% ___ _

Hispanic or Latino Origin or Descent
Yes 32 8.9% 25 23.6%
16.570 <0.001
No 329 91.1% 81 76.4%







Demographic Characteristics of Survey Respondents in Counties with HMOs: HMO vs. MediPass


MediPass Enrollees in
iP Enr in HMO Enrollees Tests of Significance
Counties with HMOs

N % or s N % or s 2 ort P
Race
White 249 66.9% 55 50.5% 9.840 0.002
Black or African-American 96 25.8% 43 39.4% 7.637 0.006
Asian 11 0.3% 2 1.8% N/A N/A
Native Hawaiian or Pacific Islander 1 0.3% 0 0.0% N/A N/A
American Indian or Alaska Native 14 3.8% 2 1.8% N/A N/A

Primary Language Spoken at Home
English 352 95.1% 90 82.6%
Spanish 13 3.5% 17 15.6% 21.202 <0.001
Other 5 1.4% 2 1.8%







Satisfaction with the Medicaid Program Among Enrollees Residing in Counties with HMOs: HMO vs.
MediPass

MediPass Enrollees in
Medis E s in HMO Tests of Significance
Counties with HMOs

N % or s N %or s 2 or t p
Received New Doctor or Nurse When Enrolled
Yes 146 40.3% 53 49.5%
2.862 0.091
No 216 59.7% 54 50.5%

Problem Getting Satisfactory Doctor or Nurse
Big Problem 35 24.3% 8 15.1%
Small Problem 12 8.3% 8 15.1% 0.148 0.7
No Problem 97 67.4% 37 69.8%

Has a Personal Doctor or Nurse
Yes 289 78.1% 80 74.1%
2.862 0.091
No 81 21.9% 28 25.9%

Mean Rating of Doctor or Nurse 8.46 1.990 8.41 2.194 0.208 0.835

Needed a Specialist
Yes 171 46.3% 51 47.2%
0.026 0.872
No 198 53.7% 57 52.8%

How Much of a Problem to Get Referral for
Specialist
Big Problem 45 26.6% 11 21.6%
Small Problem 21 12.4% 7 13.7% 0.535 0.765
Not a Problem 103 60.9% 33 64.7%

Saw a Specialist
Yes 148 40.1% 45 41.7%
0.084 0.772
No 221 59.9% 63 58.3%

Mean Rating of Specialist 8.34 2.374 8.50 2.169 -0.397 0.692
I I







Satisfaction with the Medicaid Program Among Enrollees Residing in Counties with HMOs: HMO vs.
MediPass

MediPass Enrollees in
MediPs E s in HMO Tests of Significance
Counties with HMOs

N %ors N % or s 2 ort P
Called Doctor's Office for Self During Regular
Hours
Yes 202 55.0% 53 49.1%
1.195 0.274
No 165 45.0% 55 50.9%


Received Needed Help or Advice as a Result of Call
Never 14 6.9% 4 7.5%
Sometimes 46 22.8% 12 22.6%
0.07 0.995
Usually 37 18.3% 9 17.0%
Always 105 52.0% 28 52.8%

Made Appointment for Routine Health Care
Yes 255 69.7% 71 65.1%
0.802 0.37
No 111 30.3% 38 34.9%

Got Appointment for Routine Health Care as Soon
as Wanted
Never 11 4.3% 4 5.7%
Sometimes 45 17.8% 12 17.1%
1.2 0.753
Usually 61 24.1% 13 18.6%
Always 136 53.8% 41 58.6%

Had Illness or Injury Needing Immediate Care
Yes 193 52.0% 45 41.3%
3.885 0.049
No 178 48.0% 64 58.7%

Got Immediate Care for Illness or Injury as Soon as
Wanted
Never 11 5.8% 2 4.5%
Sometimes 37 19.4% 7 15.9%
0.512 0.916
Usually 36 18.8% 8 18.2%
Always 107 56.0% 27 61.4%







Satisfaction with the Medicaid Program Among Enrollees Residing in Counties with HMOs: HMO vs.
MediPass

MediPass Enrollees in
MediPs E s in HMO Tests of Significance
Counties with HMOs

S % ors % or s 2 or t

Number of Times Went to Doctor's Office or Clinic
for Care for Self
none 60 16.7% 24 22.9%
1 time 54 15.0% 17 16.2%
2 times 49 13.6% 15 14.3%
3 times 41 11.4% 14 13.3% 4.749 0.576
4 times 25 7.0% 8 7.6%
5 to 9 times 80 22.3% 17 16.2%
10+ times 50 13.9% 10 9.5%

How Much of a Problem to Get Necessary Care
Big Problem 33 11.1% 8 9.9%
Small Problem 46 15.5% 14 17.3% 0.218 0.897
Not a Problem 217 73.3% 59 72.8%


Delays While Waiting for Approval from Program
Big Problem 32 10.7% 11 13.6%
Small Problem 27 9.1% 13 16.0% 4.189 0.123
Not a Problem 239 80.2% 57 70.4%

Waited More Than 15 Minutes Past Appointment
Time to See Provider
Never 54 18.2% 21 25.6%
Sometimes 123 41.6% 32 39.0%
2.305 0.512
Usually 40 13.5% 9 11.0%
Always 79 26.7% 20 24.4%







Satisfaction with the Medicaid Program Among Enrollees Residing in Counties with HMOs: HMO vs.
MediPass

MediPass Enrollees in
MediPs E s in HMO Tests of Significance
Counties with HMOs

N %ors % or s _2 or t p
Office Staff at Doctor's Office Were Courteous and
Respectful
Never 4 1.3% 3 3.7%
Sometimes 28 9.4% 6 7.3%
2.363 0.5
Usually 38 12.7% 9 11.0%
Always 229 76.6% 64 78.0%

Office Staff at Doctor's Office Were Helpful
Never 8 2.7% 3 3.7%
Sometimes 43 14.5% 13 16.0%
1.255 0.74
Usually 59 19.9% 12 14.8%
Always 187 63.0% 53 65.4%

Doctor or Other Provider Listened Carefully
Never 9 3.0% 2 2.5%
Sometimes 41 13.7% 11 13.8%
0.165 0.983
Usually 49 16.4% 12 15.0%
Always 200 66.9% 55 68.8%

Difficulty Communicating With Doctor Due to
Language Barriers
Never 236 79.2% 61 74.4%
Sometimes 33 11.1% 14 17.1%
2.346 0.504
Usually 6 2.0% 2 2.4%
Always 23 7.7% 5 6.1%

Doctor Explained Things So That Patient Could
Understand
Never 8 2.7% 4 4.9%
Sometimes 44 14.8% 10 12.3%
1.334 0.721
Usually 41 13.8% 12 14.8%
Always 204 68.7% 55 67.9%







Satisfaction with the Medicaid Program Among Enrollees Residing in Counties with HMOs: HMO vs.
MediPass

MediPass Enrollees in
MediPs E s in HMO Tests of Significance
Counties with HMOs

N % or s N %or s 2 or t P
Doctor Showed Respect for What Patient Said
Never 10 3.3% 3 3.6%
Sometimes 31 10.4% 10 12.0%
0.904 0.824
Usually 52 17.4% 11 13.3%
Always 206 68.9% 59 71.1%

Doctor Spent Enough Time With Patient
Never 14 4.7% 4 4.9%
Sometimes 46 15.5% 15 18.3%
0.443 0.931
Usually 56 18.9% 14 17.1%
Always 181 60.9% 49 59.8%

Mean Rating of All Health Care, from All Doctors.322.103 8.292.124 0.112 0.911
8.32 + 2.103 8.29 + 2.124 0.112 0.911
and Health Providers

Needed an Interpreter to Speak with Doctor or
Other Health Provider
Yes 20 5.4% 8 7.3%
0.593 0.441
No 352 94.6% 101 92.7%

(Of those who needed an Interpreter)
How Often Received a Needed Interpreter
Never 4 20.0% 2 25.0%
Sometimes 6 30.0% 2 25.0%
N/A N/A
Usually 3 15.0% 1 12.5%
Always 7 35.0% 3 37.5%

Use Current Medicaid Program for All or Most of
Health Care
Yes 227 97.0% 85 97.7%
S0.112 0.738
No 7 3.0% 2 2.3%







Satisfaction with the Medicaid Program Among Enrollees Residing in Counties with HMOs: HMO vs.
MediPass

MediPass Enrollees in
MediPs E s in HMO Tests of Significance
Counties with HMOs

N % or s N %or s 2 or t p
Patient Choice of Program
Chose Myself 76 34.1% 60 71.4%
34.492 <0.001
Was Told 147 65.9% 24 28.6%

Received Information About Program When
Enrolled
Yes 126 57.5% 61 74.4%
7.204 0.007
No 93 42.5% 21 25.6%

How Much of Given Information Was Correct
All of It 81 66.9% 35 58.3%
Most of It 35 28.9% 16 26.7%
7.281 0.063
Some of It 5 4.1% 8 13.3%
None of It 0 0.0% 1 1.7%

Looked for Information in Written Materials from
Program
Yes 81 22.0% 40 37.0%
9.944 0.002
No 287 78.0% 68 63.0%

How Much of a Problem to Find or Understand
Information in Written Materials
Big Problem 14 17.3% 4 9.8%
Small Problem 17 21.0% 8 19.5% 1.415 0.493
Not a Problem 50 61.7% 29 70.7%

Called Program's Enrollee Service for Information
or Help
Yes 88 23.7% 51 47.2%
22.432 0.001
No 283 76.3% 57 52.8%







Satisfaction with the Medicaid Program Among Enrollees Residing in Counties with HMOs: HMO vs.
MediPass

MediPass Enrollees in
MediPs E s in HMO Tests of Significance
Counties with HMOs

N %ors N % or s 2 or t p
(Of those who called Enrollee Services)
How Much of a Problem to Get Needed Help from
Program's Enrollee Service
Big Problem 15 17.0% 10 19.6%
Small Problem 23 26.1% 11 21.6% 0.416 0.812
Not a Problem 50 56.8% 30 58.8%

Experience with Paperwork for Program
Yes 75 20.5% 19 17.6%
0.441 0.507
No 291 79.5% 89 82.4%

How Much of a Problem was the Paperwork for
Program
Big Problem 8 10.7% 3 15.8%
Small Problem 18 24.0% 5 26.3% 0.505 0.777
Not a Problem 49 65.3% 11 57.9%

Mean Overall Rating of Health Plan 7.79 2.577 8.02 2.402 -0.807 0.42








Demographic Characteristics of Survey Respondents: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)



MediPass Enrollees
MediPass Enrollees: All MediPass Enrollees: All MediPass Enrollees MediPass Enrollees
Residents in Non HMO Tests of Significance
Counties (Weighted) Counties (Unweighted) ntResiding in HMO Counties
Counties

NN %ors N % ors N % ors N % ors 2ort P
Self Assessed Overall Health
Excellent 15 8.0% 62 8.4% 33 9.0% 29 7.8%
Very Good 23 12.2% 90 12.1% 44 12.0% 46 12.3%
Good 44 23.9% 171 23.1% 79 21.5% 92 24.6% 2.131 0.712
Fair 62 33.7% 247 33.3% 120 32.7% 127 34.0%
Poor 41 22.2% 171 23.1% 91 24.8% 80 21.4%/_

Age
18-24 years 11 6.1% 45 6.2% 23 6.3% 22 6.0%
25-34 years 40 22.3% 163 22.4% 82 22.6% 81 22.2%
35-44 years 48 26.5% 194 26.6% 98 27.0% 96 26.3% 6.014 0.305
45-54 years 39 21.8% 164 22.5% 87 24.0% 77 21.1%
55-64 years 39 21.3% 144 19.8% 61 16.8% 83 22.7%
65+ years 4 2.0% 18 2.5% 12 3.3% 6 1.6%_

Sex
Male 40 21.6% 165 22.1% 85 22.8% 80 21.3% 0.296 0.604
Female 146 78.4% 583 77.9% 287 77.2% 296 78.7%_

Highest School Grade Completed
8th Grade or Less 23 12.6% 93 12.6% 46 12.5% 47 12.6%
Some High School, but Didn't Graduate 53 28.6% 213 28.8% 107 29.2% 106 28.5%
High School Graduate, or GED 68 36.7% 272 36.8% 136 37.1% 136 36.6% 1.006 0.962
Some College or 35 19.0% 137 18.5% 65 17.7% 72 19.4%
2-Year College Degree 4 2.4% 18 2.4% 9 2.5% 9 2.4%
4-Year College Degree or More 1 0.7% 6 0.8% 4 1.1% 2 0.5%_

Hispanic or Latino Origin or Descent
Yes 14 7.6% 58 8.0% 32 8.9% 26 7.2% 0.711 0.39
No 167 92.4% 666 100.0%m 329 91.1% 337 92.8%








Demographic Characteristics of Survey Respondents: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)



MediPass Enrollees
MediPass Enrollees: All MediPass Enrollees: All MediPass Enrollees MediPass Enrollees
Residents in Non HMO Tests of Significance
Counties (Weighted) Counties (Unweighted) ntResiding in HMO Counties
Counties

N % or s N % ors N % ors N % or s x ort P
Race (choose all that apply)
White 111 59.7% 465 62.2% 249 66.9% 216 57.4% 7.1580.007
Black or African-American 64 34.3% 235 31.4% 96 25.8% 139 37.0% 10.812 0.001
Asian 1 0.5% 3 0.4% 1 0.3% 2 0.5% N/A
Native Hawaiian or Pacific Islander 01 0.0% 1 0.1% 0 0.0% 1 0.3% N/A
American Indian or Alaska Native 6 3.1% 25 3.3%1 14 3.8% 11 2.9% 0.406 0.524



* Data are weighted to account for the proportion of Medicaid enrollees residing in counties which offer HMOs vs. those residing in counties which do not offer HMOs.








Satisfaction with the Medicaid Program: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)



Residents of All Residents of All Residents of Non HMO Residents of HMO Ts o
Tests of Significance
Counties (Weighted) Counties Counties Counties

N %ors N %ors N % ors N % or s 2ort P
Received New Doctor or Nurse When Enrolled
Yes 73 40.1% 294 40.2% 146 40.3% 148 40.0%
0.008 0.927
No 110 59.9% 438 59.8% 216 59.7% 222 60.0%

Problem Getting Satisfactory Doctor or Nurse
Big Problem 13 18.1% 59 20.2% 35 24.3% 24 16.2%
Small Problem 11 14.9% 37 12.7% 12 8.3% 25 16.9% 6.585 0.037
No Problem 49 67.0% 196 67.1% 97 67.4% 99 66.9%

Has a Personal Doctor or Nurse
Yes 146 78.3% 584 78.7% 289 78.1% 295 79.3%
0.158 0.691
No 39 20.8% 158 21.3% 81 21.9% 77 20.7%

Mean Rating of Doctor or Nurse 8.68 2.016 8.60 2.006 8.46 1.990 8.74 2.015 1.691 0.091

Needed a Specialist
Yes 88 47.6% 350 47.2% 171 46.3% 179 48.0%
0.202 0.653
No 97 52.4% 392 52.8% 198 53.7% 194 52.0%

How Much of a Problem to Get Referral for
Specialist_
Big Problem 21 24.7% 87 25.4% 45 26.6% 42 24.1%
Small Problem 13 15.2% 49 14.3% 21 12.4% 28 16.1% 1.036 0.596
Not a Problem 52 60.0% 207 60.3% 103 60.9% 104 59.8%

Saw a Specialist
Yes 77 41.7% 306 41.1% 148 40.1% 158 42.1%
0.315 0.575
No 108 58.3% 438 58.9% 221 59.9% 217 57.9%

Mean Rating of Specialist 8.32 2.282 8.33 2.304 8.34 2.374 8.32 2.245 0.09 0.928

Called Doctor's Office for Self During Regular
Hours
Yes 97 51.8% 394 53.1% 202 55.0% 192 51.2%
1.099 0.295
No 89 47.7% 348 46.9% 165 45.0% 183 48.8%

Received Needed Help or Advice as a Result of
S8 31 7 6Call 1
Never 8 8.5% 31 7.9% 14 6.9% 17 9.0%


0.617


Sometimes 1 18 19.2%1 80 20.5%0 46 22.8%1 34 18.0%
Usually 1 17 18.1%1 71 18.2%0 37 18.3%1 34 18.0%






Satisfaction with the Medicaid Program: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)








Satisfaction with the Medicaid Program: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)



Residents of All Residents of All Residents of Non HMO Residents of HMO Ts o
Tests of Significance
Counties (Weighted) Counties Counties Counties

N %ors N %ors N %ors N %or s 2ort P

Made Appointment for Routine Health Care
Yes 126 68.1% 507 68.6% 255 69.7% 252 67.6%
0.383 0.536
No 59 31.9% 232 31.4% 111 30.3% 121 32.4%

Got Appointment for Routine Health Care as Soon
as Wanted
Never 5 4.1% 21 4.2% 11 4.3% 10 4.0%
Sometimes 19 15.3% 81 16.1% 45 17.8% 36 14.5%
4.201 0.241
Usually 25 20.1% 108 21.5% 61 24.1% 47 18.9%
Always 75 60.5% 292 58.2% 136 53.8% 156 62.7%

Had Illness or Injury Needing Immediate Care
Yes 91 48.8% 372 49.9% 193 52.0% 179 47.9%
1.29 0.256
No 95 51.2% 373 50.1% 178 48.0% 195 52.1%

Got Immediate Care for Illness or Injury as Soon as
Wanted
Never 6 7.0% 24 6.5% 11 5.8% 13 7.4%
Sometimes 17 18.9% 70 19.1% 37 19.4% 33 18.8%
0.413 0.937
Usually 16 18.3% 68 18.5% 36 18.8% 32 18.2%
Always 50 55.8% 205 55.9% 107 56.0% 98 55.7%

Number of Times Went to Doctor's Office or Clinic
for Care for Self
none 34 18.7% 131 18.0% 60 16.7% 71 19.2%
1 time 29 16.0% 114 15.7% 54 15.0% 60 16.3%
2 times 26 14.0% 101 13.9% 49 13.6% 52 14.1%
3 times 20 10.8% 80 11.0% 41 11.4% 39 10.6%
4 times 13 7.0% 51 7.0% 25 7.0% 26 7.0%
5 to 9 times 38 20.6% 154 21.2% 80 22.3% 74 20.1%
10+ times 24 13.0% 97 13.3% 50 13.9% 47 12.7%

How Much of a Problem to Get Necessary Care
Big Problem 21 14.0% 77 13.0% 33 11.1% 44 14.9%
Small Problem 26 17.3% 99 16.7% 46 15.5% 53 17.9% 2.845 0.241
Not a Problem 101 68.7% 416 70.3% 217 73.3% 199 67.2%








Satisfaction with the Medicaid Program: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)



Residents of All Residents of All Residents of Non HMO Residents of HMO Ts o
Tests of Significance
Counties (Weighted) Counties Counties Counties

N %ors N %ors N %ors N %or s 2ort P

Delays While Waiting for Approval from Program
Big Problem 16 11.1% 65 11.0% 32 10.7% 33 11.2%
Small Problem 16 11.1% 62 10.5% 27 9.1% 35 11.9% 1.384 0.501
Not a Problem 114 77.8% 465 78.5% 239 80.2% 226 76.9%

Waited More Than 15 Minutes Past Appointment
Time to See Provider
Never 30 20.0% 115 19.4% 54 18.2% 61 20.6%
Sometimes 64 43.4% 253 42.7% 123 41.6% 130 43.9%
1.533 0.675
Usually 18 12.0% 74 12.5% 40 13.5% 34 11.5%
Always 36 24.6% 150 25.3% 79 26.7% 71 24.0%

Office Staff at Doctor's Office Were Courteous and
Respectful
Never 4 2.6% 13 2.2% 4 1.3% 9 3.0%
Sometimes 12 8.4% 52 8.7% 28 9.4% 24 8.1%
2.246 0.523
Usually 19 12.5% 75 12.6% 38 12.7% 37 12.5%
Always 113 76.5% 456 76.5% 229 76.6% 227 76.4%

Office Staff at Doctor's Office Were Helpful
Never 6 3.7% 20 3.4% 8 2.7% 12 4.0%
Sometimes 19 12.9% 80 13.5% 43 14.5% 37 12.5%
2.549 0.467
Usually 26 17.3% 108 18.2% 59 19.9% 49 16.5%
Always 98 66.0% 386 65.0% 187 63.0% 199 67.0%

Doctor or Other Provider Listened Carefully
Never 5 3.3% 19 3.2% 9 3.0% 10 3.4%
Sometimes 21 14.0% 83 13.9% 41 13.7% 42 14.1%
0.477 0.924
Usually 22 14.9% 92 15.4% 49 16.4% 43 14.4%
Always 101 67.8% 403 67.5% 200 66.9% 203 68.1%

Difficulty Communicating with Doctor Due to
Language Barriers
Never 114 76.9% 463 77.7% 236 79.2% 227 76.2%
Sometimes 23 15.4% 83 13.9% 33 11.1% 50 16.8%
10.249 0.017
Usually 5 3.3% 17 2.9% 6 2.0% 11 3.7%
Always 7 4.4% 33 5.5% 23 7.7% 10 3.4%








Satisfaction with the Medicaid Program: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)



Residents of All Residents of All Residents of Non HMO Residents of HMO Ts o
Tests of Significance
Counties (Weighted) Counties Counties Counties

N %ors N %ors N %ors N %ors ort P
Doctor Explained Things so Patient Could
Understand
Never 7 4.8% 24 4.0% 8 2.7% 16 5.4%
Sometimes 21 14.0% 85 14.3% 44 14.8% 41 13.8%
2.845 0.416
Usually 20 13.3% 80 13.5% 41 13.8% 39 13.1%
Always 100 67.9% 405 68.2% 204 68.7% 201 67.7%

Doctor Showed Respect for What Patient Said
Never 8 5.2% 27 4.5% 10 3.3% 17 5.7%
Sometimes 17 11.2% 65 10.9% 31 10.4% 34 11.4%
3.25 0.355
Usually 22 14.7% 93 15.6% 52 17.4% 41 13.8%
Always 102 69.0% 411 69.0% 206 68.9% 205 69.0%

Doctor Spent Enough Time With Patient
Never 7 5.0% 29 4.9% 14 4.7% 15 5.1%
Sometimes 27 18.3% 103 17.3% 46 15.5% 57 19.2%
Usually 23 15.3% 98 16.5% 56 18.9% 42 14.1%
Always 91 61.5% 364 61.3% 181 60.9% 183 61.6%

Mean Rating of All Health Care, from All Doctors
SHealth Carefrom A Doctors 8.21 2.234 8.25 2.186 8.32 2.103 8.18 2.267 0.792 0.429
and Health Providers

Needed an Interpreter to Speak with Doctor or
Other Health Provider
Yes 8 4.1% 34 4.5% 20 5.4% 14 3.7%
1.178 0.278
No 179 95.9% 714 95.5% 352 94.6% 362 96.3%

How Often Received a Needed Interpreter
Never 2 30.9% 9 26.5% 4 20.0% 5 35.7%
Sometimes 2 29.0% 10 29.4% 6 30.0% 4 28.6%
1.311 0.726
Usually 1 9.6% 4 11.8% 3 15.0% 1 7.1%
Always 2 30.5% 11 32.4% 7 35.0% 4 28.6%

Received Information About Program When
Enrolled
Yes 73 63.5% 280 61.5% 126 57.5% 154 65.3%
No1 22.6%2 175 38.5% 932.8 0.091
No 42 22.6% 175 38.5% 93 42.5% 82 34.7%








Satisfaction with the Medicaid Program: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)



Residents of All Residents of All Residents of Non HMO Residents of HMO Ts o
Tests of Significance
Counties (Weighted) Counties Counties Counties

N %ors N %ors N %ors N %ors 2ort P
How Much of Given Information Was Correct
All of It 43 61.0% 169 62.8% 81 66.9% 88 59.5%
Most of It 22 31.7% 83 30.9% 35 28.9% 48 32.4%
2.895 0.408
Some of It 5 6.8% 16 5.9% 5 4.1% 11 7.4%
None of It 0 0.5% 1 0.4% 0 0.0% 1 0.7%

Looked for Information in Written Materials from
Program
Yes 41 22.4% 165 22.2% 81 22.0% 84 22.5%
0.022 0.883
No 144 77.6% 577 77.8% 287 78.0% 290 77.5%

How Much of a Problem to Find or Understand
Information in Written Materials
Big Problem 7 16.0% 27 16.5% 14 17.3% 13 15.7%
Small Problem 10 25.2% 39 23.8% 17 21.0% 22 26.5% 0.695 0.707
Not a Problem 24 58.7% 98 59.8% 50 61.7% 48 57.8%

Called Program's Enrollee Service for Information
or Help
Yes 48 25.6% 186 25.0% 88 23.7% 98 26.2%
0.613 0.434
No 138 74.4% 559 75.0% 283 76.3% 276 73.8%

How Much of a Problem to Get Needed Help from
Program's Enrollee Service
Big Problem 13 27.7% 45 24.2% 15 17.0% 30 30.6%
Small Problem 10 20.9% 42 22.6% 23 26.1% 19 19.4% 4.867 0.088
Not a Problem 25 51.5% 99 53.2% 50 56.8% 49 50.0%

Experience with Paperwork for Program
Yes 32 17.6% 137 18.6% 75 20.5% 62 16.7%
1.74 0.187
No 152 82.4% 600 81.4% 291 79.5% 309 83.3%

How Much of a Problem was the Paperwork for
Program
Big Problem 6 18.2% 21 15.3% 8 10.7% 13 21.0%
Small Problem 7 23.0% 32 23.4% 18 24.0% 14 22.6% 2.816 0.245
Not a Problem 19 58.9% 84 61.3% 49 65.3% 35 56.5%

Mean Overall Rating of Health Plan 7.93 2.467 7.88 2.502 7.79 2.577 7.98 2.425 -0.978 0.328







Satisfaction with the Medicaid Program: MediPass Enrollees Residing in HMO Counties vs. Non HMO Counties (weighted)


* Data are weighted to account for the proportion of Medicaid enrollees residing in counties which offer HMOs vs. those residing in counties which do not offer HMOs.







Demographic Characteristics of Survey Respondents by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail
Tests of Significance
N=943 N=748 N=195

N % ors N % or s N % or s 2 ort P
Self-Assessed Overall Health
Excellent 77 8.3% 62 8.4% 15 8.1%
Very Good 111 12.0% 90 12.1% 21 11.4%
Good 222 24.0% 171 23.1% 51 27.6% 1.688 0.793
Fair 306 33.0% 247 33.3% 59 31.9%
Poor 210 22.7% 171 23.1% 39 21.1%

Age
18-24 years 56 6.1% 45 6.2% 11 5.9%
25-34 years 201 22.0% 163 22.4% 38 20.3%
35-44 years 241 26.3% 194 26.6% 47 25.1%
3.459 0.630
45-54 years 207 22.6% 164 22.5% 43 23.0%/
55-64 years 190 20.8% 144 19.8% 46 24.6%
65+ years 20 2.2% 18 2.5% 2 1.1%_

Sex
Male 213 22.7% 165 22.1% 48 25.1%
0.819 0.366
Female 726 77.3% 583 77.9% 143 74.9%

Highest School Grade Completed
8th Grade or Less 128 13.9% 93 12.6% 35 19.2%
Some High School, but Didn't Graduate 266 28.9% 213 28.8% 53 29.1%
High School Graduate, or GED 337 36.6% 272 36.8% 65 35.7% .50 0
7.520 0.185
Some College or 163 17.7% 137 18.5% 26 14.3%
2-Year College Degree 20 2.2% 18 2.4% 2 1.1%
4-Year College Degree or More 7 0.8% 6 0.8% 1 0.5%

Hispanic or Latino Origin or Descent
Yes 68 7.7% 58 8.0% 10 6.1%
0.692 0.405
No 820 92.3% 666 92.0% 154 93.9%







Demographic Characteristics of Survey Respondents by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail
N=I943 N=748 N=195 Tests of Significance
N=943 N=748 N=195

N % or s N % or s 2 ort P
Race
White 593 62.9% 465 62.2% 128 65.6% 0.800 0.371
Black or African-American 292 31.0% 235 31.4% 57 29.2% 0.346 0.556
Asian 4 0.4% 3 0.4% 1 0.5% N/A N/A
Native Hawaiian or Pacific Islander 1 0.1% 1 0.1% 0 0.0% N/A N/A
American Indian or Alaska Native 31 3.3% 25 3.3% 6 3.1% 0.034 0.853

Primary Language Spoken at Home
English 896 95.8% 712 95.6% 184 96.8%
Spanish 27 2.9% 23 3.1% 4 2.1% 0.630 0.730
Other 12 1.3% 10 1.3% 2 1.1%







Satisfaction with the Medicaid Program by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail Tests of Significance

N %ors N % ors N % ors ,2 ort P
Received New Doctor or Nurse When Enrolled
Yes 391 42.6% 294 40.2% 97 52.2%
8.715 0.003
No 527 57.4% 438 59.8% 89 47.8%

Problem Getting Satisfactory Doctor or Nurse
Big Problem 72 19.5% 59 20.2% 13 16.9%
Small Problem 57 15.4% 37 12.7% 20 26.0% 8.258 0.016
No Problem 240 65.0% 196 67.1% 44 57.1%

Has a Personal Doctor or Nurse
Yes 720 77.6% 584 78.7% 136 73.1%
2.67 0.102
No 208 22.4% 158 21.3% 50 26.9%

Needed a Specialist
Yes 448 48.2% 350 47.2% 98 52.4%
1.64 0.2
No 481 51.8% 392 52.8% 89 47.6%


How Much of a Problem to Get Referral for Specialist
Big Problem 103 24.2% 87 25.4% 16 19.3%
Small Problem 63 14.8% 49 14.3% 14 16.9% 1.46 0.482
Not a Problem 260 61.0% 207 60.3% 53 63.9%

Saw a Specialist
Yes 394 42.3% 306 41.1% 88 47.1%
2.153 0.142
No 537 57.7% 438 58.9% 99 52.9% 2


Called Doctor's Office for Self During Regular Hours
Yes 518 55.6% 394 53.1% 124 65.3% 9.05
No 414 44.4%89.065 0.0036 34.7%
Nlo 414 44.4% 348 46.9% 66 34.7%







Satisfaction with the Medicaid Program by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail Tests of Significance

N %or s N %ors N %ors 2 ort P



Received Needed Help or Advice as a Result of Call
Ever 34 6.8% 31 7.9% 3 2.8%
Sometimes 100 20.1% 80 20.5% 20 18.9%
Jsually 100 20.1% 71 18.2% 29 27.4%
always 263 52.9% 209 53.5% 54 50.9%

Made Appointment for Routine Health Care
Yes 650 70.0% 507 68.6% 143 75.7%
lJo 278 30.0% 232 31.4% 46 24.3% 3.57

Got Appointment for Routine Health Care as Soon as
NVanted
ever 23 3.7% 21 4.2% 2 1.6%
Sometimes 105 16.8% 81 16.1% 24 19.5%
Jsually 147 23.5% 108 21.5% 39 31.7%
Always 350 56.0% 292 58.2% 58 47.2%

Had Illness or Injury Needing Immediate Care
Yes 469 50.1% 372 49.9% 97 50.8%
_Jo 467 49.9% 373 50.1% 94 49.2%

Got Immediate Care for Illness or Injury as Soon as
Wanted
ever 26 5.8% 24 6.5% 2 2.4%
Sometimes 84 18.7% 70 19.1% 14 16.9%
Jsually 91 20.2% 68 18.5% 23 27.7%
Always 249 55.3% 205 55.9% 44 53.0%







Satisfaction with the Medicaid Program by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail Tests of Significance

N %ors N %ors N %ors 2 or t P
Number of Times Went to Doctor's Office or Clinic for
Care for Self
ione 162 17.7% 131 18.0% 31 16.4%
1 time 133 14.5% 114 15.7% 19 10.1%
2 times 132 14.4% 101 13.9% 31 16.4%
3 times 103 11.2% 80 11.0% 23 12.2% 14.318 0.026
times 78 8.5% 51 7.0% 27 14.3%
5 to 9 times 190 20.7% 154 21.2% 36 19.0%
10+ times 119 13.0% 97 13.3% 22 11.6%

How Much of a Problem to Get Necessary Care
Big Problem 91 12.3% 77 13.0% 14 9.7%
Small Problem 126 17.1% 99 16.7% 27 18.6% 1.34 0.512
Not a Problem 520 70.6% 416 70.3% 104 71.7%


Delays While Waiting for Approval from Program
Big Problem 76 10.3% 65 11.0% 11 7.5%
Small Problem 84 11.4% 62 10.5% 22 15.0% 3.506 0.173
Not a Problem 579 78.3% 465 78.5% 114 77.6%

NVaited More Than 15 Minutes Past Appointment Time
to See Provider
Never 139 18.8% 115 19.4% 24 16.3%
Sometimes 313 42.4% 253 42.7% 60 40.8%
1.753 0.625
Jsually 97 13.1% 74 12.5% 23 15.6%
Always 190 25.7% 150 25.3% 40 27.2%

Office Staff at Doctor's Office Were Courteous and
Respectful
Never 17 2.3% 13 2.2% 4 2.7%
Sometimes 62 8.3% 52 8.7% 10 6.8%
4.629 0.201
Jsually 103 13.9% 75 12.6% 28 19.0%
Always 561 75.5% 456 76.5% 105 71.4%_







Satisfaction with the Medicaid Program by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail Tests of Significance

N %or s N %ors N %ors 2 ort P
Office Staff at Doctor's Office Were Helpful_
Ever 23 3.1% 20 3.4% 3 2.0%
Sometimes 92 12.4% 80 13.5% 12 8.2%
Jsually 153 20.6% 108 18.2% 45 30.6%
Always 473 63.8% 386 65.0% 87 59.2%

Doctor or Other Provider Listened Carefully
Ever 26 3.5% 19 3.2% 7 4.7%
Sometimes 101 13.6% 83 13.9% 18 12.2%
Jsually 125 16.8% 92 15.4% 33 22.3%
Always 493 66.2% 403 67.5% 90 60.8%

Difficulty Communicating With Doctor Due to
Language Barriers
ever 569 76.6% 463 77.7% 106 72.1%
Sometimes 106 14.3% 83 13.9% 23 15.6%
Jsually 24 3.2% 17 2.9% 7 4.8%
Always 44 5.9% 33 5.5% 11 7.5%

Doctor Explained Things So That Patient Could
Understand
ever 32 4.3% 24 4.0% 8 5.4%
Sometimes 111 15.0% 85 14.3% 26 17.7%
Jsually 107 14.4% 80 13.5% 27 18.4%
Always 491 66.3% 405 68.2% 86 58.5%

Doctor Showed Respect for What Patient Said
Ever 34 4.6% 27 4.5% 7 4.8%
Sometimes 88 11.8% 65 10.9% 23 15.6%
Jsually 126 17.0% 93 15.6% 33 22.4%
Always 495 66.6% 411 69.0% 84 57.1%_







Satisfaction with the Medicaid Program by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail Tests of Significance

N %or s N %ors N %ors 2 ort P
Doctor Spent Enough Time With Patient
Ever 38 5.1% 29 4.9% 9 6.3%
Sometimes 129 17.5% 103 17.3% 26 18.1%
Jsually 139 18.8% 98 16.5% 41 28.5%
Always 432 58.5% 364 61.3% 68 47.2%

Needed an Interpreter to Speak with Doctor or Other
Health Provider
Yes 41 4.4% 34 4.5% 7 3.8%
lJo 893 95.6% 714 95.5% 179 96.2%

Of those who needed an Interpreter)
How Often Received a Needed Interpreter
Never 10 25.0% 9 26.5% 1 16.7%
Sometimes 12 30.0% 10 29.4% 2 33.3%
Jsually 4 10.0% 4 11.8% 0 0.0%
Always 14 35.0% 11 32.4% 3 50.0%

Use Current Medicaid Program for All or Most of Health
Care
Yes 587 96.9% 470 96.9% 117 96.7% 11.1
Jo 19 3.1% 15 3.1% 4 3.3%

Patient Choice of Program
hose Myself 243 41.5% 197 42.4% 46 38.3%
0.639 0.424
Nas Told 342 58.5% 268 57.6% 74 61.7%


Received Information About Program When Enrolled
Yes 345 60.2% 280 61.5% 65 55.1%
_Jo 228 39.8% 175 38.5% 53 44.9%







Satisfaction with the Medicaid Program by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail Tests of Significance

N %ors N % ors N % ors 2rt P
How Much of Given Information Was Correct
,11 of It 210 63.6% 169 62.8% 41 67.2%
VIost of It 95 28.8% 83 30.9% 12 19.7%
N/A N/A
Some of It 22 6.7% 16 5.9% 6 9.8%
Jone of It 3 0.9% 1 0.4% 2 3.3%

Looked for Information in Written Materials from
Program
Yes 204 22.0% 165 22.2% 39 21.2%
0.093 0.76
_Jo 722 78.0% 577 77.8% 145 78.8%

How Much of a Problem to Find or Understand
information in Written Materials
3ig Problem 35 17.8% 27 16.5% 8 24.2%
Small Problem 49 24.9% 39 23.8% 10 30.3% 2.385 0.303
Jot a Problem 113 57.4% 98 59.8% 15 45.5%

Called Program's Enrollee Service for Information or
Help
Yes 226 24.3% 186 25.0% 40 21.6%
0.901 0.342
_Jo 704 75.7% 559 75.0% 145 78.4%

Of those who called Enrollee Services)
How Much of a Problem to Get Needed Help from
Program's Enrollee Service
3ig Problem 57 25.7% 45 24.2% 12 33.3%
Small Problem 49 22.1% 42 22.6% 7 19.4% 1.324 0.516
Jot a Problem 116 52.3% 99 53.2% 17 47.2%

Experience with Paperwork for Program
Yes 182 19.7% 137 18.6% 45 24.1%
742 80.3%600 81.4%142 75.9% 2.827 0.093
lo 742 80.3% 600 81.4% 142 75.9%







Satisfaction with the Medicaid Program by Mode of Survey Administration unweightedd)


Telephone + Mail Telephone Mail Tests of Significance

N %or s N %orors N % ors I 2 ort P

Program
Big Problem 27 15.3% 21 15.3% 6 15.0%
Small Problem 43 24.3% 32 23.4% 11 27.5% 0.295 0.863
Not a Problem 107 60.5%1 84 61.3% 23 57.5%




University of Florida Home Page
© 2004 - 2010 University of Florida George A. Smathers Libraries.
All rights reserved.

Acceptable Use, Copyright, and Disclaimer Statement
Last updated October 10, 2010 - - mvs