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Comparison of Preventive Care in Medicaid Managed Care and Medicaid Fee for Service in Institutions and Private Practices

  • Gerry Fairbrother
    Correspondence
    Address correspondence to Gerry Fairbrother, PhD, Division of Health and Science Policy, The New York Academy of Medicine, 1216 Fifth Ave, New York, NY 10029-5293
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  • Karla L. Hanson
    Affiliations
    From the Division of Health and Science Policy, New York Academy of Medicine (Dr Fairbrother), Health Services and Management Program, Robert J. Milano Graduate School of Management and Urban Policy, New School University (Dr Hanson), Department of Multicultural and Community Affairs, Mount Sinai School of Medicine (Dr Butts), and Bureau of Immunization, New York City Department of Health (Dr Friedman), New York, NY. Dr Butts was with Family Health Services at the New York City Department of Health at the time of this study. Dr Fairbrother was with the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, at the time of this study.
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  • Gary C. Butts
    Affiliations
    From the Division of Health and Science Policy, New York Academy of Medicine (Dr Fairbrother), Health Services and Management Program, Robert J. Milano Graduate School of Management and Urban Policy, New School University (Dr Hanson), Department of Multicultural and Community Affairs, Mount Sinai School of Medicine (Dr Butts), and Bureau of Immunization, New York City Department of Health (Dr Friedman), New York, NY. Dr Butts was with Family Health Services at the New York City Department of Health at the time of this study. Dr Fairbrother was with the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, at the time of this study.
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  • Stephen Friedman
    Affiliations
    From the Division of Health and Science Policy, New York Academy of Medicine (Dr Fairbrother), Health Services and Management Program, Robert J. Milano Graduate School of Management and Urban Policy, New School University (Dr Hanson), Department of Multicultural and Community Affairs, Mount Sinai School of Medicine (Dr Butts), and Bureau of Immunization, New York City Department of Health (Dr Friedman), New York, NY. Dr Butts was with Family Health Services at the New York City Department of Health at the time of this study. Dr Fairbrother was with the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, at the time of this study.
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      Objective.—To compare preventive screening for children in Medicaid managed care (MMC) with children in Medicaid fee for service (M-FFS) in private and institutional settings.
      Methods.—The sample included randomly selected institutions and private practice physicians in New York City. Within setting, children in MMC and M-FFS were sampled randomly and charts reviewed for immunizations and lead and anemia screening.
      Results.—In both institutions and private practices, children enrolled in MMC appeared more likely to be up-to-date than their M-FFS counterparts for immunizations (institution, P < .01; private practice, P < .05), lead screening (institution, P < .01; private practice, P < .01), and anemia screening (institution, P < .01; private practice, P < .01). However, children in MMC had more visits (P < .01) and were followed up for a longer time (P < .01). After controlling for these variables, effects of MMC diminished and only remained significant for screening among private physicians. When considering 10 different attributes of managed care plans, no clear pattern of association with better preventive care services was observed.
      Conclusion.—The positive effect of managed care on preventive care services was largely explained by more visits and longer follow-up time; however, there were differences between institutions and private practices, with enrollment in MMC associated with some positive effect on screenings in private practices.

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