Use of Health Care Before and During Citicare

The Citicare program was implemented in Jefferson County, Kentucky, between July 1982 and June 1983. Approximately 40,000 AFDC-related Medicaid recipients were enrolled. Granted federal waivers, the program established a primary care network with capitation payment and physician sharing of savings. Interviews were conducted with 300 recipients just prior to the program and with 348 recipients 1 year later. No changes occurred in the rate of hospital inpatient stays, ambulatory care, or prescribed drugs. There was, however, a 40% reduction in hospital emergency room use and a shift in the locus of care from doctors' offices to health centers and clinics. Recipients' perceptions of the quality of care received in health centers and clinics increased, but declined for care in physicians' offices. Although the program met most of its objectives, it did not gain physician support and was terminated by a new governor.