Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Medicaid Physician and Outpatient Department Use


Differences in hospital use described in the preceding section are more evident comparing White to non-White IHSS recipients than in comparisons among recipient-provider groups. In this section, we examine the use of physician and outpatient departments as a potential influence on hospital use. Access to medical care is necessary to assure appropriate health care and condition management, but measurement of the levels of use are confounded by the inter-relationship between health status and need for care. For example, individuals with declining health status or with acute problems are more likely to seek care than those not experiencing such problems. Unraveling the cause-effect pattern is beyond the scope of this analysis, but statistics have been compiled to first descriptively compare any use between recipients by age and provider group and among race/ethnic groups, and then to compare use adjusting for health status and other characteristics.

Table 19 shows an important contrast among IHSS recipients. About 20% do not have any claims with vendor codes for either physician services (including MDs, nurse practitioners, medical groups, surgi-centers, and rural clinics), or outpatient department (including hospital-based and other organized outpatient departments) use in 2005. These rates differ somewhat among IHSS recipient age groups, and between provider types. Table 20 recalculates access to medical care, to add any Medicaid claims for ER use. These combined rates reflect about a 2%-3% increase in the percentage of recipients having access to Medicaid medical care. None of these estimates include medical care encounters that are billed solely to non-Medicaid sources without requiring a Medicaid co-payment or other Medicaid claims-based record of the encounter. Minor children recipients as a group have lower unadjusted rates of access to medical care than either of the other recipient age groups.

Table 21 extends the analysis of Medicaid-reimbursed medical care by using logistic regression to adjust for health status and other recipient attributes. As shown in this table, Parent providers of minor children, and Spouse providers of adult IHSS recipients have a higher likelihood of any medical care use compared to those with Non-Relative providers after adjusting for health and functional status. Comparisons between IHSS recipients with other relatives and non-relatives are not statistically different. Adults with Parent providers have a lower likelihood of medical care use than do those with non-relatives as paid IHSS providers.34

The differences in hospital use comparing non-White race/ethnic groups to Whites (Table 16) are not broadly “explained” by differences in medical care use. After adjusting for health conditions and functional limitations, there are no statistically significant differences in the likelihood of medical care use comparing non-White to White race/ethnic groups among IHSS recipients age 3-17 and comparing Hispanic and Asians to White among recipients age 65+. Adult African-American IHSS recipients, on the other hand, were less likely to use medical services than Whites. Non-aged adult Hispanic and Asian recipients tended to have a higher likelihood of medical care use than Whites of the same age.

34. Similar analyses were conducted using logistic regression models comparing medical care use, excluding the use of ERs. The results relative to IHSS provider groups and in comparisons of non-White race/ethnic groups were similar to the results in Table 21. They are available in Appendix D, Table D-1.

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