Comparison of preventive care in Medicaid managed care and Medicaid fee for service in institutions and private practices.
OBJECTIVE
To compare preventive screening for children in Medicaid managed care (MMC) with children in Medicaid fee for service (M-FFS) in private and institutional settings.


METHODS
The sample included randomly selected institutions and private practice physicians in New York City. Within setting, children in MMC and M-FFS were sampled randomly and charts reviewed for immunizations and lead and anemia screening.


RESULTS
In both institutions and private practices, children enrolled in MMC appeared more likely to be up-to-date than their M-FFS counterparts for immunizations (institution, P <.01; private practice, P <.05), lead screening (institution, P <.01; private practice, P <.01), and anemia screening (institution, P <.01; private practice, P <.01). However, children in MMC had more visits (P <.01) and were followed up for a longer time (P <.01). After controlling for these variables, effects of MMC diminished and only remained significant for screening among private physicians. When considering 10 different attributes of managed care plans, no clear pattern of association with better preventive care services was observed.


CONCLUSIONS
The positive effect of managed care on preventive care services was largely explained by more visits and longer follow-up time; however, there were differences between institutions and private practices, with enrollment in MMC associated with some positive effect on screenings in private practices.
Fairbrother
G
G
Division of Health and Science Policy, New York Academy of Medicine, NY 10029-5293, USA. gfairbro@nyam.org
Hanson
K L
KL
Butts
G C
GC
Friedman
S
S
D003430:Cross-Sectional Studies; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007223:Infant; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration*; D009519:New York City; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011331:Private Practice