title: Managed care organization characteristics and outpatient specialty care use among children with chronic illness.
abstract: BACKGROUND
  Limited information is available about managed care organization (MCO) characteristics that influence outpatient physician specialist use among children with chronic conditions.
  
  
  OBJECTIVE
  To examine the association between MCO characteristics and outpatient physician specialist use among children with chronic conditions who were receiving care in MCOs in which primary care providers (PCPs) served as gatekeepers for referrals and who were publicly insured.
  
  
  METHODS
  A total of 2333 children who had been diagnosed with a chronic condition and had functional limitations, an increased need for or use of health care services beyond what children normally use, and/or dependence on medications or home medical equipment were included in the study. The odds of an outpatient physician specialist visit 1 year after study entry were examined as a function of child health and sociodemographic characteristics, MCO characteristics, the child's prior specialty care use, and provider availability in the MCO service delivery area.
  
  
  RESULTS
  Children cared for in MCOs with lower percentages of PCPs paid on a fee-for-service basis (odds ratio: 0.95; 95% confidence interval: 0.92-0.98), with higher percentages of pediatricians in the PCP network (odds ratio: 1.17; 95% confidence interval: 1.07-1.29), and offering financial incentives for meeting quality of care standards (odds ratio: 1.71; 95% confidence interval: 1.28-2.29) had greater odds of outpatient physician specialist visits. Black children had odds of specialty care that were approximately one half those of white children. Children with prior physician specialist use were 52% more likely to have a physician specialist visit in the year after study entry. The children's diagnoses and condition consequences were not related significantly to the odds of a specialty visit.
  
  
  CONCLUSIONS
  Specific MCO characteristics were associated with greater specialty care use among a group of low-income children with chronic conditions. Such information should be used to improve the structure of managed care arrangements for these vulnerable children.
authors.affiliation: Department of Epidemiology and Health Policy Research, Institute for Child Health Policy, University of Florida, 1329 SW 16th St, Room 5130, Gainesville, FL 32608, USA. eas@ichp.ufl.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shenkman
authors.forename: Lili
authors.initials: L
authors.lastname: Tian
authors.forename: John
authors.initials: J
authors.lastname: Nackashi
authors.forename: Desmond
authors.initials: D
authors.lastname: Schatz
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002204:Capitation Fee; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D018588:Fee-for-Service Plans; D005260:Female; D005431:Florida; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008511:Medicine / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D020380:Needs Assessment / Q000706:statistics & numerical data; D010372:Pediatrics; D010816:Physician Incentive Plans / Q000191:economics; D010821:Physicians, Family; D011203:Poverty; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive; D013038:Specialization; D044465:White People / Q000706:statistics & numerical data