Using patient evaluations to empirically assess medicaid programs for social justice.

The Medicaid program serves a social justice function in the United States. The program's effectiveness in achieving this aim is traditionally evaluated in terms of resource allocation and distribution using measures and concepts such as financing, access, and enrollment. The patient's perspective in ascertaining the quality of actual care delivery has not been utilized to ascertain social justice. This paper uses the confidential evaluations of 40% of the hospitals in Rhode Island, New Jersey, and Connecticut to compare the experiences of Medicaid patients versus privately insured patients hospitalized in 2002 and cross-validates results in independent samples collected in 2003 and 2004. The results found that Medicaid patients experienced interactions with physicians that resulted in lower ratings of statistical and practical significance than privately insured patients. Admissions and discharge processes were also rated lower by Medicaid patients. The "hotel" amenities provided by hospitals-room and meals-were rated more favorably by Medicaid patients. Yet there were no significant differences in Medicaid and private insurance patients' overall satisfaction with their acute care experience. Medicaid patients' evaluations should be considered a key component of evaluating whether a state's Medicaid program has achieved patients' and society's need for social justice.