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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References
- Medicaid managed care in thirteen states.Health Aff (Millwood). 1998; 17: 43-63
- Health insurance coverage of special needs children.Health Policy Center, The Urban Institute, Washington, DC2003
- Managed care and children: an overview.Future Child. 1998; 8: 25-38
- Certain Children with Special Health Care Needs: An Assessment of State Activities and Their Relationship to HCFA's Interim Criteria.National Academy for State Health Policy, Portland, ME2000
- 2005 National Summary of State Medicaid Managed Care Programs.Centers for Medicare & Medicaid Services (CMS), Washington, DC2005
- Medicaid maternal and child health care: prepaid plans vs. private fee-for-service.Res Nurs Health. 1990; 13: 163-171
- Access to office-based physicians under capitation reimbursement and Medicaid case management. Findings from the Children's Medicaid Program.Med Care. 1990; 28: 59-68
Johnson RW, ed. Chronic Care Initiatives in HMOs. Princeton, NJ: Robert Wood Johnson Foundation; 1992.
- Managed Care and Chronic Illness: Challenges and Opportunities.Aspen Publishers, Frederick, Md1996
- Monitoring and evaluating managed care for children with chronic illnesses and disabilities.Pediatrics. 1996; 98: 952-958
- Monitoring health care for children with chronic conditions in a managed care environment.Matern Child Health J. 1997; 1: 15-23
- Managed care and the quality of children's health services.Future Child. 1998; 8: 60-75
- Role of insurance for children with special health care needs: a synthesis of the evidence.Pediatrics. 2006; 118: e1027-e1038
- Is Medicaid, the largest insurer of children with special health care needs, in danger?.Pediatrics. 2003; 112: 668-669
- The brave new bipartisan world of health care reform: how will low-income families with children with special health care needs fare?.Pediatrics. 2004; 114: 489-490
- Improving Population Health: The Uses of Systematic Reviews.Milbank Memorial Fund, New York, NY2007
- FY 2008 Number of Children Ever Enrolled Year—SCHIP by Program Type.US Department of Health and Human Services, Washington, DC2009
- Access, utilization, quality, and effective coverage: an integrated conceptual framework and measurement strategy.Soc Sci Med. 2005; 61: 97-109
- Systems to rate the strength of scientific evidence.Agency for Healthcare Research and Quality, Rockville, Md2002 (Report No. 02-E016)
- Current methods of the US Preventive Services Task Force: a review of the process.Am J Prev Med. 2001; 20: 21-35
- Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization.Pediatrics. 1998; 101: E1-E10
- Changes in continuity of enrollment among high-risk children following implementation of TennCare.Arch Pediatr Adolesc Med. 1999; 153: 1145-1149
- Impact of the Oregon Health Plan on children with special health care needs.Pediatrics. 2001; 107: 736-743
- Improved health care among children with special health care needs after enrollment into the State Children's Health Insurance Program.Ambul Pediatr. 2007; 7: 10-17
- Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.Pediatrics. 2006; 117: 486-496
- Managed care of children with special health care needs: the ABC Program.Clin Pediatr (Phila). 1999; 38: 153-160
- Caregivers' ratings of access: do children with special health care needs fare better under fee-for-service or partially capitated managed care?.Med Care. 2007; 45: 146-153
- Do children receiving supplemental security income who are enrolled in Medicaid fare better under a fee-for-service or comprehensive capitation model?.Pediatrics. 2004; 114: 196-204
- The impact of managed care enrollment on emergency department use among children with special health care needs.Med Care. 2007; 45: 139-145
- Plan choice and changes in access to care over time for SSI-eligible children with disabilities.Inquiry. 2005; 42: 145-159
- Partially capitated managed care versus FFS for special needs children.Health Care Financ Rev. 2007; 28: 109-123
- Effects of managed care on service use and access for publicly insured children with chronic health conditions.Pediatrics. 2007; 119: 956-964
- Effects of the State Children's Health Insurance Program expansions on children with chronic health conditions.Pediatrics. 2005; 116: e34-e42
- The transformation of child health in the United States.Health Aff (Millwood). 2004; 23: 9-25
- Medicaid and managed care.N Engl J Med. 1995; 332: 1727-1731
- Effects of Medicaid managed care programs on health services access and use.Health Serv Res. 2003; 38: 575-594
- Well-baby care in Connecticut's Medicaid managed-care program.Conn Med. 2002; 66: 515-521
- The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions.Health Serv Res. 2005; 40: 19-38
- Evaluation of Medicaid managed care for children: access and satisfaction.Am J Public Health. 2000; 90: 1947-1948
- Medicaid managed care and health care access for adult beneficiaries with disabilities.Health Serv Res. 2009; 44: 1521-1541
- Managed care for children: effect on access to care and utilization of health services.Future Child. 1998; 8: 39-59
- Evaluating medicaid managed care programs for children.Ambul Pediatr. 2001; 1: 112-116
- Medicaid Managed Care Cost Savings–A Synthesis of Fourteen Studies.America's Health Insurance Plans, Falls Church, Va2004
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.