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Related Experiment Videos

Managed competition for the poor: more promise than value?

T P Weil1

  • 1Bedford Health Associates, Inc., Asheville, NC 28801.

Journal of Health Care for the Poor and Underserved
|January 1, 1994
PubMed
Summary
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Managed care plans for Medicaid recipients show mixed results, with higher costs but improved access. Challenges in eligibility and service delivery complicate care for the underserved in managed competition models.

Area of Science:

  • Health Services Research
  • Health Policy Analysis

Background:

  • Managed competition is a proposed cornerstone of US health care reform.
  • Medicaid recipients' experiences with managed care plans have yielded mixed outcomes.

Purpose of the Study:

  • To evaluate the effectiveness and challenges of managed care plans for Medicaid recipients within the context of health care reform proposals.

Main Methods:

  • Analysis of capitated managed care programs compared to fee-for-service arrangements for Medicaid populations.
  • Assessment of cost, access to care, and administrative challenges.

Main Results:

  • Capitated managed care programs exhibit higher costs than traditional fee-for-service models.
  • Perceived improvements in access to care partially offset increased expenditures.

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  • Significant administrative difficulties exist in eligibility determination, benefit delivery, and payment for services.

    • Conclusions:

    • Providing comprehensive health care for the poor and underserved through managed competition presents substantial logistical and financial hurdles.
    • The complexities of managed care for vulnerable populations require careful consideration in health care reform efforts.