title: Nonprice competition and quality of care in managed care: the New York SCHIP market.
abstract: OBJECTIVE
  To examine the effect of nonprice competition among managed care plans on the quality of care in the New York SCHIP market.
  
  
  METHODS
  U.S. Census 2000; 2002 New York State Managed Care Plan Performance Report; and 2001 New York State Managed Care Annual Enrollment Report.
  
  
  METHODS
  Each market is defined as a county, and competition is measured as the number of plans in a market. Quality of care is measured in percentages using three Consumer Assessment of Health Plans Survey and three Health Plan Employer Data and Information Set scores. Two-stage least squares is applied to address the endogeneity between competition and the quality of care, using population as an instrument.
  
  
  RESULTS
  We find a negative association between competition and quality of care. An additional managed care plan is significantly associated with a decrease of 0.40-2.31 percentage points in four out of six quality measures. After adjusting for production cost, a positive correlation is observed between price and quality measures across different pricing regions.
  
  
  CONCLUSIONS
  It seems likely that pricing policy is a constraint on quality production, although it may not be interpreted as a causal relationship and further study is needed.
authors.affiliation: Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, USA.
authors.forename: Hangsheng
authors.initials: H
authors.lastname: Liu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Phelps
mesh_terms: D000293:Adolescent; D000385:Aid to Families with Dependent Children; D019352:Censuses; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000592:standards*; D002669:Child Welfare; D002675:Child, Preschool; D004465:Economic Competition / Q000191:economics*; D006801:Humans; D008329:Managed Care Programs; D009518:New York; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D014481:United States