Journal Issue: Health Care Reform Volume 3 Number 2 Summer/Fall 1993
Managed care has been embraced by many as a vehicle to slow the rapid growth in health care costs in the United States while safeguarding the quality of health care and improving access. Growth of participation in managed care plans in both the private and public sectors has been explosive during the past five years, and managed care concepts may play a pivotal role in health care reform. Despite the widespread interest in managed care and its explosive growth, there is still considerable disagreement about the effects of managed care on the cost and quality of the health care received by children and pregnant women.
In this paper, Deborah Freund of the School of Public and Environmental Affairs at Indiana University and Eugene Lewit of the Center for the Future of Children examine the evidence about the claimed advantages and potential disadvantages of managed care for children and pregnant women. They find that, on balance, available research does not support most claims of reduced costs and/or improved quality and access for children and pregnant women enrolled in managed care. There is also little evidence that the incentives for cost savings which are features of any managed care plans have deleterious effects on the health of children and pregnant women. However, with the explosive growth in enrollment in managed care plans has come a period of innovation in plan characteristics. Accordingly, Freund and Lewit point out that past experience with managed plans may not be adequate to support firm conclusions about the future impact of managed care on children. For this reason, this paper concludes with a number of research and implementation issues that need to be addressed to achieve a tolerable level of comfort regarding the status of children in any managed health care plan. These issues include preserving existing doctor-patient relationships, protecting traditional safety net providers and high-cost enrollees, balancing incentives for the efficient provision of care with exposure to financial risks, and maintaining adequate oversight of operational and marketing activities and quality of care.