Preventive care in managed care and fee-for-service plans: is it cost effective?
Lack of coverage, knowledge, and physician guidance, and low socioeconomic status are major barriers to receiving preventive care. Compared with fee-for-service insurance, managed care promotes prevention through more generous coverage, physician incentives, and patient education, and members of MCOs use more preventive services than do members of fee-for-service plans. However, cost effectiveness of prevention has not been previously examined. A study of seven preventive services suggests that managed care enrollees more frequently obtained four preventive services, including two less-effective ones. For less-effective services, it may be prudent to base disease-risk assessment on key factors other than age and sex, and screen only patients at high risk. Effective screening strategies must be identified, especially for the underserved, low-income population.
Wang
Y Richard
YR
Health Services Research and Policy Analysis, Public Policy Department, AstraZeneca Pharmaceuticals, Wilmington, Delaware, USA.
Pauly
Mark V
MV
D003362:Cost-Benefit Analysis; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D006293:Health Promotion; D006302:Health Services Research; D006801:Humans; D015273:Insurance Selection Bias; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008403:Mass Screening / Q000191:economics; D010342:Patient Acceptance of Health Care; D010808:Physical Examination / Q000706:statistics & numerical data; D011203:Poverty; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D018570:Risk Assessment; D014481:United States