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Impact of Managed Care on Publicly Insured Children with Special Health Care Needs

  • Lynne C. Huffman
    Correspondence
    Address correspondence to Lynne C. Huffman, MD, Stanford University School of Medicine, Division of General Pediatrics, CHC, 650 Clark Way, Palo Alto, California 94304.
    Affiliations
    Division of General Pediatrics, Stanford University School of Medicine, Stanford, Calif (Drs Huffman, Chamberlain, and Wise); Stanford University School of Medicine, Stanford, Calif (Dr Brat); Lucile Packard Children's Hospital, Stanford, Calif (Dr Chamberlain and Dr Wise); and Center for Policy, Outcomes and Prevention and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Wise)
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  • Gabriel A. Brat
    Affiliations
    Division of General Pediatrics, Stanford University School of Medicine, Stanford, Calif (Drs Huffman, Chamberlain, and Wise); Stanford University School of Medicine, Stanford, Calif (Dr Brat); Lucile Packard Children's Hospital, Stanford, Calif (Dr Chamberlain and Dr Wise); and Center for Policy, Outcomes and Prevention and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Wise)
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  • Lisa J. Chamberlain
    Affiliations
    Division of General Pediatrics, Stanford University School of Medicine, Stanford, Calif (Drs Huffman, Chamberlain, and Wise); Stanford University School of Medicine, Stanford, Calif (Dr Brat); Lucile Packard Children's Hospital, Stanford, Calif (Dr Chamberlain and Dr Wise); and Center for Policy, Outcomes and Prevention and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Wise)
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  • Paul H. Wise
    Affiliations
    Division of General Pediatrics, Stanford University School of Medicine, Stanford, Calif (Drs Huffman, Chamberlain, and Wise); Stanford University School of Medicine, Stanford, Calif (Dr Brat); Lucile Packard Children's Hospital, Stanford, Calif (Dr Chamberlain and Dr Wise); and Center for Policy, Outcomes and Prevention and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif (Dr Wise)
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      Objective

      The aim of this review was to evaluate the impact of managed care on publicly insured children with special health care needs (CSHCN).

      Methods

      We conducted a review of the extant literature. Using a formal computerized search, with search terms reflecting 7 specific outcome categories, we summarized study findings and study quality.

      Results

      We identified 13 peer-reviewed articles that evaluated the impact of Medicaid and State Children's Health Insurance program (SCHIP) Managed Care (MSMC) on health services delivery to populations of CSHCN, with all studies observational in design. Considered in total, the available scientific evidence is varied. Findings concerning care access demonstrate a positive effect of MSMC; findings concerning care utilization were mixed. Little information was identified concerning health care quality, satisfaction, costs, or health status, whereas no study yielded evidence on family impact.

      Conclusion

      The available studies suggest that the evaluated record of MSMC for CSHCN has been mixed, with considerable heterogeneity in the definition of CSHCN, program design, and measured outcomes. These findings suggest caution should be exercised in implementing MSMC for CSHCN and that greater emphasis on health outcomes and cost evaluations is warranted.

      Key Words

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