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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Article Info
Publication History
Accepted:
September 3,
2009
Received:
August 2,
2007
Footnotes
Dr Brat is currently at Johns Hopkins Hospital Department of Surgery, Baltimore, MD.
Identification
Copyright
© 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
