Background: How can state Medicaid programs accomplish necessary cost-control reforms while preserving or improving the intent of the program? How can private insurers maximize satisfaction among enrollees while also managing a bottom line? In 2005, Florida began a Medicaid Reform pilot program intended to contain spending while providing enrollees new opportunity for choice-making and involvement in health care decisions. Analysis of this program provides a unique, quasi-experimental opportunity to address whether choice-making matters for how enrollees feel about their health plan, their health care, and/or about government more broadly. Methods: Using original survey data of 6,904 enrollees in Florida's Medicaid Reform pilot program, this dissertation addresses various ways in which "choice-making" relates to enrollee attitudes toward health plans, health care, and government institutions. Multiple regression and multiple imputation models were applied. The data and approach in this study provide a novel opportunity for evaluation in three respects: (1) the data permit analysis within a comparable population where some individuals exercised and/or knew of various aspects of "choice" and others did not; (2) due to the basic criteria required of all Medicaid health plans, enrollees by and large receive the same product regardless of which plan they are in, permitting a compelling evaluation of the independent impact of choice; and (3) the data permit analysis of links between the perceived responsiveness of a public program and enrollee feelings of efficacy. Results:This dissertation tests the presumption used by the founders of Medicaid Reform that giving enrollees increased choice-making opportunity would result in greater levels of satisfaction with health care services; and finds that both choice-making, and the quality of the choice-making environment, are significant predictors of enrollees attitudes toward their health plans, their health care, and toward government in general. The following aspects of choice are consistently significant and positive in relation to enrollee satisfaction with health plans, health care, and government: having chosen one's health plan; having heard about Choice Counseling; having had a positive experience with Choice Counseling; having enough doctors to choose from; knowing how to change plans if one so desires; and having more than one option for care. However, enrollees who have a negative experience with the choice-making process are significantly less likely to report satisfaction, implying that it is not enough to simply offer choice but that these programs must be implemented in an effective, user-friendly way. These findings reinforce and expand upon academic theories on "choice", fill in gaps in the policy feedback framework, and provide novel and applicable information to policymakers in and beyond the realm of health care. / A Dissertation submitted to the Department of Political Science in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2012. / October 5, 2012. / health care administration, health insurance, health policy, Medicaid, public opinion, survey research / Includes bibliographical references. / Charles Barrilleaux, Professor Co-Directing Dissertation; Jason Barabas, Professor Co-Directing Dissertation; Carol Weissert, Committee Member; William Weissert, Committee Member; Lance deHaven Smith, University Representative.
| Identifer | oai:union.ndltd.org:fsu.edu/oai:fsu.digital.flvc.org:fsu_183236 |
| Contributors | Cyphers, Karen Halperin (authoraut), Barrilleaux, Charles (professor co-directing dissertation), Barabas, Jason (professor co-directing dissertation), Weissert, Carol (committee member), Weissert, William (committee member), Smith, Lance deHaven (university representative), Department of Political Science (degree granting department), Florida State University (degree granting institution) |
| Publisher | Florida State University, Florida State University |
| Source Sets | Florida State University |
| Language | English, English |
| Detected Language | English |
| Type | Text, text |
| Format | 1 online resource, computer, application/pdf |
| Rights | This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). The copyright in theses and dissertations completed at Florida State University is held by the students who author them. |
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