Utilization of services by chronically ill people in managed care and indemnity plans: implications for quality.
Because incentives for managed care organizations favor cost containment, concerns have been raised that quality of care has suffered, especially for chronically ill people. This study compares utilization rates of managed care and indemnity patients with three chronic conditions, using five years of claims records (1993-97) from private plans and Medicare in one market. Findings show that for all three conditions, managed care patients were more likely to see both primary care physicians and specialists within a year, but less likely to use a hospital emergency department or to be an inpatient. Assuming that patients with these illnesses should see a physician annually and that good primary care reduces the need for emergency and inpatient services, it appears that the patterns of care used by chronically ill managed care patients in this market do not reflect lower quality than that received by similar indemnity patients.
Davidson
Stephen M
SM
Boston University School of Management, Strategy and Policy Department, MA 02215, USA.
Davidson
Harriet
H
Miracle-McMahill
Heidi
H
Oakes
J Michael
JM
Crawford
Sybil
S
Blumenthal
David
D
Valentine
Daniel P
DP
D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000191:economics* / Q000628:therapy; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D006302:Health Services Research; D006333:Heart Failure / Q000191:economics* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive; D014600:Utilization Review