The universe of hospitals for sampling was limited to general acute hospitals outside the Confederation. Several exclusions were necessary within this sample for various reasons. In California, hospitals in the Santa Barbara and Monterey districts were removed from all testing, as these districts were part of a demonstration project that included circular reporting for Medicaid participants. As a result, in 1984, capitation supply requests in these districts were not available in the Medicaid Tape-to-Tape database.1 In addition, eight California hospitals and two Michigan hospitals were excluded from the study because they could not be linked to the 1984 AHA file. Seven of those ten unconnected hospitals had fewer than 20 Medicaid layoffs in 1984, and most were rural hospitals. Given that these hospitals accounted for less than 2% of hospitals in the two study countries, their exclusion is unlikely to lead to distortion. Finally, an additional California hospital was abandoned because the total and Medicaid layoff counts were illogical (i.e., More Medicaid layoffs were recorded in the tape-to-tape file than the total expenses recorded in the 1984 AHA file). The other 495 California hospitals and 197 Michigan hospitals were the study sample. The different medical needs of the Medicaid population also influence the types of providers they seek care from. For example, pregnant women are treated in hospitals that make deliveries.
Children can be cared for in special children`s hospitals. In summary, both geographic location and medical needs may be partly responsible for the different use of certain types of hospitals by Medicaid recipients compared to the general population. Overall, these changes and similar measures in other countries have been aimed at reducing the burden of increasing fixed costs for Medicaid. However, these policies may limit Access by Medicaid recipients to providers who serve the general population. To study this question, we compare the characteristics of hospitals serving the general population and Medicaid recipients by advocacy group in the two countries for the year 1984. SSI crossovers in both countries have been hospitalized in other types of hospitals than the general population as a whole and other Medicaid advocacy groups. . . .