Alessandrini et al. [37] |
2001 |
553 |
Single hospital |
Prospective cohort |
Utilization |
χ2; % with a specialty visit; number of visits |
Managed care vs. fee-for-service |
10% vs. 12%, p = 0.68; 0.2 vs. 0.2, p = 0.65 |
MC mandated' no patient selection |
Cartland and Yudkowsky [43] |
1992 |
1,264 |
American Academy of Pediatrics Fellows |
Cross-sectional |
Referral rates |
χ2; frequency of referral of MCO patients |
Managed care vs. fee-for-service |
More frequent: 2.5%; less frequent, 8.7%; p < 0.05 |
Study is of physician behavior; no patient selection |
Cuesta et al. [44] |
2000 |
49 |
Single hospital |
Retrospective cohort |
Referral type |
χ2
|
Initial referral is to rheumatologist vs. orthopedic surgeon |
Managed care: 83% vs. 17%; "Traditional commercial": 58% vs. 42%; p = NS |
Examines insurance type at initial referral, prior to diagnosis |
Ferris et al. [39] |
2002 |
59,952 |
Single MCO |
Quasi-experimental |
Utilization |
t-test; number of specialist visits and proportion new specialist visits |
With gatekeeping vs. without gatekeeping |
Visits: 0.28 vs. 0.28, p = NS; % new visits: 30.6% vs. 34.8%; p < 0.05 |
Single MCO initiated removal of gatekeeping; no patient choice |
Ferris et al. [45] |
2001 |
1,839 |
Single insurance plan |
Prospective cohort |
Utilization |
t-test; change in visits |
Gatekeeping vs. indemnity |
57% decrease vs. 31% increase; p = 0.005 |
Patient voluntarily selected into coverage type |
Forrest et al [24] |
1999 |
27,104 |
National practice-based research network |
Prospective |
Referral rates |
t-test, percent referred; logistic regression, likelihood of referral to specialty |
Gatekeeping vs. no gatekeeping |
Medicaid, OR = 1.86, p < 0.001; Private, OR = 1.76, p < 0.01 |
No consideration of selection into type of plan |
Garrett et al [38] |
2003 |
34,280 |
National Health Interview Survey |
Retrospective |
Utilization |
Probit; mandatory PCCM vs. FFS, mandatory HMO vs. FFS; likelihood of any specialist visit |
Fee-for-service vs. primary care case management or HMO |
PCCM = 0.003, p = NS; HMO = 0.378, p < 0.05 |
Mandatory enrollment into program type |
Lake [46] |
1999 |
12,383 |
Community Tracking Survey |
Cross-sectional |
Satisfaction |
Logistic regression; difference in percent satisfied with choice of specialists |
HMO vs. non-HMO |
-8.3%, p < 0.05 |
No consideration of selection into coverage type |
Mitchell, Khatutsky, and Swigonski [40] |
2001 |
966 |
Single SCHIP |
Cross-sectional |
Unmet need |
χ2; percent with unmet need for specialist |
Managed care vs. fee-for-service |
6.0% vs. 10.6%, p = NS |
Patients seek managed care exemptions |
Perlstein et al. [15] |
1997 |
544 |
Regional cardiac registry |
Retrospective cohort |
Time to referral |
t-test; mean age at referral |
Managed care vs. "commercial" |
140 days vs. 80 days, p < 0.05 |
No consideration of selection into coverage type |
Price et al. [34] |
1999 |
94 |
Single hospital |
Cross-sectional |
Utilization |
t-test; number of specialist visits |
Capitated plan vs. fee-for-service |
All: 7.5 vs. 6, p = NS; asthma-related: 5 vs. 4, p,0.05 |
No consideration of selection into coverage type |
Roberto et al. [53] |
2005 |
935 |
Single Medicaid program |
Quasi-experimental |
Utilization |
Probit; change in access to specialist |
Fee-for-service vs. partially capitated managed care |
b = 0.221, p < 0.05 |
Voluntary selection into plan type |
Shenkman at al. [42] |
2004 |
2,333 |
Single SCHIP |
Cross-sectional |
Utilization |
Logistic regression; likelihood of a specialist visit |
Plans with certain managed care characteristics vs. those without |
Percent paid on FFS basis: 0.950, p = 0.003; Bonus for quality profile: 1.714, p = 0.0003 |
Mandatory enrollment into specific plan |
Shields, et al. [41] |
2002 |
6,231 |
Single Medicaid program |
Cross-sectional |
Utilization |
Logistic regression; likelihood of specialist visit |
HMO vs. primary care case management plan |
OR = 1.80, p < 0.05 |
Voluntary selection into coverage type |