Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To the Editor: Dr Newacheck and
colleagues1 report that poor children covered by Medicaid
have greater access to care and greater use of services than poor
children without insurance, and that poor children covered by Medicaid
have less access to care and less use than nonpoor children with
private insurance. Based on these findings, Newacheck and colleagues
conclude that there are structural problems (low reimbursement levels)
in the Medicaid program that prevent an equalization of access and use
between poor and nonpoor children. This conclusion is not justifiable.
The comparison of access and use between poor children covered by
Medicaid and nonpoor children covered by private insurance does not
identify differences in access and use due to differences in insurance
coverage, but rather differences in access and use due to differences
in insurance coverage and income. Thus, it is inappropriate to draw
inferences about the effectiveness of Medicaid coverage based on this
comparison since it is confounded by income. A better research design
would have been to compare access and use between poor children covered
by Medicaid and poor children covered by private insurance.
Kaestner R. Medicaid and Children's Access to Care. JAMA. 1999;281(14):1273–1274. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-14-jac90002
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