Evaluation of a managed care program for the non-Medicaid urban poor

In 1988, Detroit and surrounding Wayne County, Michigan, began CountyCare, an innovative managed care program designed to deliver health care services to the very poor while reducing excessive emergency-room and inpatient care. We interviewed 279 former CountyCare participants to assess differences in off-program utilization, use of clinical services, hospitalization, and patient satisfaction among respondents assigned to one of four CountyCare provider groups. Patients responded favorably to CountyCare, although off-program utilization was substantial and emergency-room and inpatient care were not significantly reduced. We conclude that how such a program is managed and administered, and a provider's degree of motivation, govern the extent to which it succeeds in reducing health care costs and increasing patient satisfaction.