Effects of medicaid managed care on quality: childhood immunizations.
BACKGROUND
Underimmunization is distributed unevenly across populations, concentrated among the impoverished. Managed care has stimulated the development of quality indicators such as immunization rates to assess health status of populations.


OBJECTIVE
To determine if enrollment in Medicaid managed care (MMC) improves quality of health care as reflected by immunization rates when compared with fee-for-service Medicaid (FFSM). DESIGN. Prospective cohort study of infants born between May 1994 and April 1995 with a 24-month follow-up period.


METHODS
Urban teaching hospital and surrounding ambulatory settings.


METHODS
Consecutive sample of infants (n = 644) enrolled in MMC or FFSM. Ninety-two percent of eligible patients were enrolled, and 87% completed follow-up.


METHODS
Up-to-date immunization status.


RESULTS
Seventy-three percent of the MMC and 72.4% of the FFSM patients were up-to-date on their immunizations: relative risk 1.01, (95% confidence interval [CI] 0.87, 1.17). No differences were found in age at immunization between the MMC and FFSM groups. After adjusting for other factors in multivariate analysis, insurance status remained unassociated with immunization status: adjusted odds ratio (OR) 1.04, (95% CI: 0.90, 1.10). Factors associated with up-to-date immunization included firstborn child, OR 2.28 (95% CI: 1.45, 3.60) and adequate maternal prenatal care, OR 2.24 (95% CI: 1.44, 3.48). Variables characterizing children less likely to be adequately immunized included father living in home with child, OR 0.53 (95% CI: 0.33, 0.85) and using private office-based primary care, OR 0.39 (95% CI: 0.23, 0.63).


CONCLUSIONS
Enrollment in MMC did not improve rates of immunizations when compared with FFSM.
Alessandrini
E A
EA
Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. alessandrini@email.chop.edu
Shaw
K N
KN
Bilker
W B
WB
Schwarz
D F
DF
Bell
L M
LM
D002648:Child; D002662:Child Health Services / Q000592:standards*; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D017589:Immunization Programs / Q000592:standards*; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D011446:Prospective Studies; D011787:Quality of Health Care; D014481:United States; D014505:Urban Population