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Related Experiment Videos

Managed care and children: an overview

D C Hughes1, H S Luft

  • 1Department of Family and Community Medicine, University of California, San Francisco, USA.

The Future of Children
|October 23, 1998
PubMed
Summary
This summary is machine-generated.

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Managed health care offers potential benefits like coordinated services for children, but also risks such as limited provider choice and incentives for reduced care. More research is needed on its impact on pediatric health outcomes.

Area of Science:

  • Pediatric Health Services
  • Health Care Management
  • Public Health Policy

Background:

  • Managed care, a complex system for financing and delivering health services, has evolved rapidly, leading to unclear definitions for consumers and practitioners.
  • A consistent feature of managed care is the use of contracted provider networks operating under organizational rules.
  • Measuring the impact of managed care on health service delivery and outcomes is challenging, particularly in pediatrics due to lagging development of quality measures.

Purpose of the Study:

  • To examine the effects of managed health care arrangements on children.
  • To lay the foundation for further research within this journal issue on pediatric managed care.

Main Methods:

  • This foundational article synthesizes existing knowledge and identifies key issues regarding managed care in pediatrics.

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  • It analyzes the inherent incentives within managed care structures that may influence service delivery and outcomes for children.

    • Main Results:

    • Managed care presents potential advantages for children, including improved care coordination, access to a "medical home," and increased preventive services.
    • Potential disadvantages include incentives for health plans to enroll healthier children and for providers to limit services, as well as restricted provider choice, especially for specialty care.

    Conclusions:

    • Despite limited data, children are increasingly enrolled in managed care plans.
    • The incentives within managed care pose both potential benefits and risks to pediatric health service delivery and outcomes.