Managed care organizational characteristics and health care use among children with special health care needs.
OBJECTIVE
To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.


METHODS
Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data.


METHODS
Cross-sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee for Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.


METHODS
The telephone and MCO-administrator survey data were linked to the enrollment and claims files.


RESULTS
The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.


CONCLUSIONS
After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns.
Shenkman
Elizabeth
E
Institute for Child Health Policy, Gainesville, Florida 32608, USA.
Wu
Samuel S
SS
Nackashi
John
J
Sherman
James
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012044:Regression Analysis; D014481:United States