For-profit and not-for-profit health plans participating in Medicaid.
The proliferation of for-profit health plans has heightened concerns about quality of care, particularly with respect to Medicaid. We undertook this study to compare for-profit and not-for-profit health plans that participate in Medicaid, examining processes of care and the organizational characteristics related to utilization management, financial incentives, and quality of care. Our findings demonstrate that for-profit and not-for-profit plans appear to be more similar than dissimilar in many areas of management, although for-profit plans are more likely to use aggressive utilization review and have slightly less developed quality management systems. On balance, these findings should reassure critics of for-profit health care.
Landon
B E
BE
Harvard Medical School and Beth Israel Deaconess Medical Center, USA.
Epstein
A M
AM
D006269:Health Facilities, Proprietary / Q000458:organization & administration*; D006801:Humans; D007256:Information Systems; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D008484:Medicaid / Q000458:organization & administration*; D009939:Organizations, Nonprofit / Q000458:organization & administration*; D010067:Ownership; D017064:Process Assessment, Health Care; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014481:United States; D014600:Utilization Review