Managed care, primary care, and quality for children

Area of Science:

• Health Services Research
• Pediatric Healthcare
• Managed Care Policy

Background:

• Managed care organizations (MCOs) use incentives to control healthcare costs and effectiveness.
• Early MCOs (prepaid group practices) showed promise for improving children's primary care.
• Recent MCO variants' impact on pediatric primary care quality is unclear and potentially negative.

Purpose of the Study:

• To evaluate the impact of newer managed care models on the quality of primary care for children.
• To assess whether current managed care structures enhance or hinder key aspects of pediatric primary care.

Main Methods:

• Review of existing evidence on managed care's effects on pediatric primary care.
• Analysis of impacts on accessibility, continuity, comprehensiveness, coordination, and outcomes.
• Comparison of newer MCO variants with early models and traditional indemnity plans.

Main Results:

• Managed care can improve initial access and reduce emergency room use for children.
• Continuity of care is threatened by provider/enrollee instability and disrupted relationships.
• Preventive services may increase, but specialty care access can be restricted; care coordination is not guaranteed.
• Evidence for improved clinical quality in newer MCOs for children is lacking.

Conclusions:

• Newer managed care models may not deliver superior primary care for children.
• The organizational structures of current MCOs may impede, rather than facilitate, quality primary care.
• More rigorous studies are essential to determine the true effect of proliferating managed care on pediatric healthcare quality.