title: Effect of different types of Medicaid managed care on childhood immunization rates.
abstract: Medicaid managed care can improve access to prevention services, such as immunization, for low-income children. The authors studied immunization rates for 7,356 children on Medicaid in three managed care programs: primary care case management (PCCM; n = 4,605), a voluntary HMO program (n = 851), and a mandatory HMO program (n = 1,900). Immunization rates (3:3:1 series) in PCCM (78%) exceeded rates in the voluntary HMO program (71%), which in turn exceeded those in the mandatory HMO program (67%). Adjusting for race, urban residence, and gender, compared to children in PCCM, children in the voluntary HMO program were less likely to complete the 3:3:1 series (OR = 0.75, CI = 0.63, 0.90), and children in the mandatory HMO program were even less likely to complete the series (OR = 0.59, CI = 0.51, 0.68). Results differed by individual HMOs. Monitoring of outcomes for all types of managed care by Medicaid agencies is imperative to assure better disease prevention for low-income children.
authors.affiliation: Virginia Commonwealth University, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cotter
authors.forename: K A
authors.initials: KA
authors.lastname: McDonald
authors.forename: D A
authors.initials: DA
authors.lastname: Parker
authors.forename: D K
authors.initials: DK
authors.lastname: McClish
authors.forename: C B
authors.initials: CB
authors.lastname: Pugh
authors.forename: V E
authors.initials: VE
authors.lastname: Bovbjerg
authors.forename: G A
authors.initials: GA
authors.lastname: Tipton
authors.forename: L F
authors.initials: LF
authors.lastname: Rossiter
authors.forename: W R
authors.initials: WR
authors.lastname: Smith
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D008484:Medicaid / Q000458:organization & administration*; D011203:Poverty; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States