Utilization of services by chronically ill people in managed care and indemnity plans: implications for quality
Department of Medicine, Division of Preventive and Behavioral Medicine
Age Factors; Aged; Asthma; Chronic Disease; Diabetes Mellitus; Health Services Research; Heart Failure, Congestive; Hospitalization; Humans; Insurance, Health; Managed Care Programs; Medicare; Patient Acceptance of Health Care; Primary Health Care; Quality of Health Care; Referral and Consultation; Reimbursement, Incentive; *Utilization Review
Life Sciences | Medicine and Health Sciences | Women's Studies
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.
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Citation: Inquiry. 2003 Spring;40(1):57-70.