Accessibility and effectiveness of care under Medicaid.

We suggest a framework for assessing the accessibility, appropriateness, and outcomes of care to Medicaid recipients and review studies in these areas. Evidence is limited, and variation among States and the paucity of national data pose further problems. There is evidence that Medicaid recipients receive less medically necessary care (e.g., prenatal care) than the insured, but evidence on the quality of their care is limited. Differences in payment rates between Medicaid and private insurance appear to explain only part of the variance. Studies have demonstrated major direct effects of diminished access on health status. Evaluation of program changes should focus on health outcomes rather than counts of services rendered.