Many states have turned to commercial health plans to serve Medicaid
beneficiaries and to achieve cost-containment goals. Assumptions that the
quality of care provided to Medicaid beneficiaries through these programs
is acceptable have not been tested.
To compare the quality of care provided to children and adolescents
in commercial and Medicaid managed care in the United States.
Design, Setting, and Population
Using 1999 data collected through the Health Plan Employer Data and
Information Set, we examined reported quality-of-care indicators for children
and adolescents. Results from 423 commercial and 169 Medicaid plans were compared.
Matched pairs analyses were performed using data from each of the 81 companies
serving both populations to control for corporate differences. Correlation
coefficients and regression procedures were used to examine observed variations
in health plan performance.
Main Outcome Measures
Quality indicators including prenatal care, childhood immunizations,
well-child visits, adolescent immunizations, and myringotomy and tonsillectomy
Using standard indicators of clinical performance, children and adolescents
enrolled in Medicaid received worse care compared with their commercial counterparts.
For most of the 81 health plans serving both populations, Medicaid enrollees
had statistically significantly (P<.001) lower
rates than commercial plans for clinical quality indicators (eg, childhood
immunization rates of 69% vs 54%); for clinical access indicators (eg, well-child
visits in the first 15 months of life, 53% vs 31%); and for common procedures
(eg, myringotomies for children aged 0-4 years, 35 vs 2 per 1000 members).
Conversely, some plans demonstrated equal and high-quality care for both populations.
Regression models failed to identify consistent plan characteristics that
explained the observed differences in quality of care.
Most commercial health plans do not deliver high-quality care on a number
of performance indicators for children enrolled in Medicaid. Policy makers
and the public need plan-specific quality information to inform purchasing