Abstract
OBJECTIVE: To examine the impact of managed care on children's access, satisfaction, use, and quality of care using nationally representative household survey data. DATA SOURCE: The 1996 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN: Bivariate and multivariate analyses are used to detect independent effects of managed care on access, satisfaction, utilization, and quality of pediatric health services. DATA COLLECTION/EXTRACTION METHODS: Data were obtained from rounds 1, 2, and 3 of the 1996 MEPS. MEPS collects data on health care use, insurance, access, and satisfaction, along with basic demographic and health status information for a representative sample of the U. S. civilian, noninstitutionalized population. Our sample consists of 5,995 children between the ages of 0 and 17. FINDINGS: Among the 18 outcome indicators examined, the bivariate analysis revealed only three statistically significant differences between children enrolled in managed care and children in traditional health plans: children enrolled in managed care were more likely to receive physician services, more likely to have access to office-based care during evening or weekend hours, and less likely to report being very satisfied with overall quality of care. However, after controlling for confounding factors, none of these differences remained statistically significant. CONCLUSIONS: Our findings suggest that there are no statistically significant differences in self-reported outcomes for children enrolled in managed care and traditional health plans. This conclusion is provisional, however, because of limitations in the data set.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Fox H. B., Wicks L. B., Newacheck P. W. Health maintenance organizations and children with special health needs. A suitable match? Am J Dis Child. 1993 May;147(5):546–552. doi: 10.1001/archpedi.1993.02160290052025. [DOI] [PubMed] [Google Scholar]
- Greenfield S., Nelson E. C., Zubkoff M., Manning W., Rogers W., Kravitz R. L., Keller A., Tarlov A. R., Ware J. E., Jr Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1624–1630. [PubMed] [Google Scholar]
- Horwitz S. M., Stein R. E. Health maintenance organizations vs indemnity insurance for children with chronic illness. Trading gaps in coverage. Am J Dis Child. 1990 May;144(5):581–586. doi: 10.1001/archpedi.1990.02150290075032. [DOI] [PubMed] [Google Scholar]
- Hughes D. C., Luft H. S. Managed care and children: an overview. Future Child. 1998 Summer-Fall;8(2):25–38. [PubMed] [Google Scholar]
- Miller R. H., Luft H. S. Does managed care lead to better or worse quality of care? Health Aff (Millwood) 1997 Sep-Oct;16(5):7–25. doi: 10.1377/hlthaff.16.5.7. [DOI] [PubMed] [Google Scholar]
- Simpson L., Fraser I. Children and managed care: what research can, can't, and should tell us about impact. Med Care Res Rev. 1999;56 (Suppl 2):13–36. [PubMed] [Google Scholar]
- Szilagyi P. G. Managed care for children: effect on access to care and utilization of health services. Future Child. 1998 Summer-Fall;8(2):39–59. [PubMed] [Google Scholar]
- Valdez R. B., Ware J. E., Jr, Manning W. G., Brook R. H., Rogers W. H., Goldberg G. A., Newhouse J. P. Prepaid group practice effects on the utilization of medical services and health outcomes for children: results from a controlled trial. Pediatrics. 1989 Feb;83(2):168–180. [PubMed] [Google Scholar]
- Weinick R. M., Cohen J. W. Leveling the playing field: managed care enrollment and hospital use, 1987-1996. Health Aff (Millwood) 2000 May-Jun;19(3):178–184. doi: 10.1377/hlthaff.19.3.178. [DOI] [PubMed] [Google Scholar]