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First published on January 28, 2008, doi:10.1177/1077558707312492

Medical Care Research and Review 2008;65:356.

A more recent version of this article appeared on June 1, 2008

Article

Are There Differential Effects of Managed Care on Publicly Insured Children With Chronic Health Conditions?

Amy Davidoff, Ph.D.1*, Ian Hill, M.P.A., M.S.W.2, Brigette Courtot2, and Emerald Adams3

1 University of Maryland-Baltimore
2 The Urban Institute
3 University of California, Berkeley

* To whom correspondence should be addressed. E-mail: adavidof{at}rx.umaryland.edu.


  Abstract
The authors use variation across states and over time in managed care (MC) programs for publicly insured children to examine whether effects differ for children with chronic health conditions (CWCHC) and those without. The authors pool data from the 1997 to 2002 National Health Interview Survey and link county, year, and health status information on type of MC programs implemented. Findings show that the effects of MC are concentrated on CWCHC and that CWCHC experience reductions in use of specialist, mental health, and prescription drugs. Capitated programs with mental health or specialty carve-outs are associated with a greater number and larger decreases in service use compared to integrated capitated programs. While it is not possible to determine whether MC programs resulted in more appropriate use of services, corresponding reductions in perceived access were not observed, suggesting that net effects of MC on service use represent improvements in care coordination.


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