Transition to managed care impacts health care service utilization by children insured by Medicaid

Area of Science:

• Pediatric Healthcare
• Health Services Research
• Public Health Policy

Background:

• Asthma is a common chronic respiratory condition in children.
• Fee-for-service models may not incentivize optimal asthma care.
• Managed care organizations aim to improve healthcare efficiency and outcomes.

Purpose of the Study:

• To assess how the shift from fee-for-service to managed care influenced asthma service use in Maryland Medicaid children.
• To analyze changes in asthma medication and healthcare visit patterns.

Main Methods:

• Analysis of healthcare claims data for children with asthma insured by Maryland Medicaid.
• Data spanned the period from 1997 to 2000, covering the transition.
• Examined trends in medication use and types of healthcare encounters.

Main Results:

• Inhaled corticosteroid use rose proportionally among all asthma medications.
• Outpatient asthma visits increased from 4.2% to 5.9% of total outpatient claims.
• Asthma-related hospitalizations and emergency department visits saw a decline.

Conclusions:

• The transition to managed care in Maryland Medicaid for children was linked to better asthma care utilization.
• Improvements included increased use of controller medications and outpatient visits.
• Decreased hospitalizations and emergency visits suggest better asthma management under managed care.