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November 19, 1997, Vol 278, No. 19 >
ARTICLE | November 19, 1997

Medicaid Managed Care and High Quality: Title and subTitle BreakCan We Have Both? FREE

Arnold M. Epstein, MD, MA
[+] Author Affiliations

Reprints: Arnold M. Epstein, MD, MA, Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (e-mail: aepstein@hsph.harvard.edu).


JAMA. 1997;278(19):1617-1621. doi:10.1001/jama.1997.03550190085052
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References

MEDICAID HAS EMBARKED on a major transition. Accelerating cost pressures in recent years have prompted states to initiate large-scale conversion of their Medicaid programs from traditional fee-for-service coverage to managed care. As a result, the number of Medicaid enrollees cared for in managed care has increased from approximately 2.5 million in 1991 to more than 13 million in June 1996.1 Most of the enrollees have been from the nondisabled, nonelderly, Aid for Dependent Children/Temporary Assistance for Needy Families population.2 The fastest growth has been in fully capitated plans, which now care for approximately 70% of the Medicaid managed care market.3

Growth of managed care for those who are privately insured has led to substantial controversy because of the financial disincentives for managed care organizations to provide sufficient medical services when these lead to increased costs. The potential impact of these disincentives on quality of care is arguably

REFERENCES

1 +
US Dept of Health and Human Services. 1996 Medicaid Managed Care Enrollment Report, Office of Managed Care, HCFA, June 1996 . Washington, DC: US Dept of Health and Human Services; 1996;.
2 +
Freund DA, Hurley RE.  Medicaid managed care: contribution to issues of health reform . Annu Rev Public Health . 1995;;16:473-495.
3 +
Rowland D, Hanson K.  Medicaid: moving to managed care: a quick summary of Medicaid managed care trends: the numbers, the models, the waivers . Health Aff (Millwood) . 1996;;15:150-152.
4 +
Sparer MS.  Medicaid managed care and the health reform debate: lessons from New York and California . J Health Polit Policy Law . 1996;;21:433-460.
5 +
The Medicaid Access Study Group.  Access of Medicaid recipients to outpatient care . N Engl J Med . 1994;;330:1426-1430.
6 +
Rowland D, Salganicoff A.  Controversy: lessons from Medicaid—improving access to office-based physician care for the low-income population . Am J Public Health . 1994;;84:550-552.
7 +
Perloff JD, Kletke PR, Fossett JW, Banks S.  Medicaid participation among urban primary care physicians . Med Care . 1997;;35:142-157.
8 +
Fossett JW, Peterson J.  Physician supply and Medicaid participation . Med Care . 1989;;27:386-396.
9 +
Sloan FA, Cromwell J, Mitchell J. Private Physicians and Public Programs . Lexington, Ky: DC Health; 1978;.
10 +
Landon BE, Tobias C, Epstein AM. Quality management by state Medicaid agencies converting to managed care: plans and current practice. JAMA. In press.
11 +
Rosenbaum S, Shin P, Smith BM, et al. Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts . Washington, DC: The George Washington University Medical Center for Health Policy Research; February 1997;.
12 +
National Academy for State Health Policy. Report to the Health Care Financing Administrator: Observations on the QARI Demonstration Project and Its Relation to Future Policy for Medicaid Managed Care . Portland, Me: National Academy for State Health Policy; May 15, 1995;.
13 +
Gold M, Felt S.  Reconciling practice and theory: challenges in monitoring Medicaid managed care quality . Health Care Financing Rev . 1995;;16:85-105.
14 +
Felt-Lisk S, St. Peter R. The Quality Assurance Reform Initiative (QARI) Demonstration for Medicaid Managed Care Final Evaluation Report, I: Summary Report . Washington, DC: Mathematica Policy Research Inc; September 1997;.
15 +
Horvath J, Kaye N, Pernice C, Snow KI. Medicaid Managed Care: A Guide for the States, I: State by State Current Medicaid Managed Care Program Scope and Operations . 3rd ed. Portland, Me: The National Academy for State Health Policy; January 1997;.
16 +
McNeil BJ, Pedersen SH, Gatsonis C.  Current issues in profiling quality of care . Inquiry . 1993;;329:1263-1265.
17 +
Jost TS.  Health system reform: forward or backward with quality oversight . JAMA . 1994;;271:1508-1511.
18 +
Kassirer JP.  The use and abuse of practice profiles . N Engl J Med . 1994;;330:634-636.
19 +
Pear R.  Florida's struggle to lift burden of Medicaid serves as model, and warning . New York Times . (April 24) ,1995;;section A:12.
20 +
General Accounting Office. Medicaid: States'Efforts to Educate and Enroll Beneficiaries in Managed Care . Washington, DC: General Accounting Office; September 17, 1996;. Report HEHS-96-184.
21 +
Epstein AM.  Performance reports on quality: prototypes, problems and prospects . N Engl J Med . 1995;;333:57-61.
22 +
Gold M, Sparer M, Chu K.  Medicaid managed care: lessons from five states . Health Aff (Millwood) . 1996;;15:153-166.
23 +
Liska D. Medicaid: Overview of a Complex Program . Washington, DC: The Urban Institute; May 1997;:1-5. Series A, No. A-8.
24 +
Kronick R, Zhou Z, Dreyfuss T.  Making risk adjustment work for everyone . Inquiry . 1995;;32:41-55.
25 +
Kronick R, Dreyfus T, Lee L, Zhou Z.  Diagnostic risk adjustment for Medicaid: the disability payment system . Health Care Financing Rev . (Spring) 1996;;17(3):7-33.
26 +
General Accounting Office. Report Cards: A Useful Concept but Significant Issues Need to Be Addressed . Washington, DC: General Accounting Office; 1994;.
27 +
The Kaiser Family Foundation and the Agency for Health Care Policy and Research. Americans as Health Care Consumers: The Role of Quality Information . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; October 1996;.
28 +
Mathematica Policy Research Inc. Experience in Collecting Selected HEDIS 2.0 Measures in the Medicaid Population . Palo Alto, Calif: The Kaiser Family Foundation; 1995;.
29 +
Henderson T, Markus AR.  Medicaid managed care: how do community health centers fit? Health Care Financing Rev . 1995;;17:135-142.
30 +
Iglehart JK.  Health policy report: Medicaid and managed care . N Engl J Med . 1995;;332:1727-1731.
31 +
Yokoi B.  A California analyst on Medicaid managed care: an up-to-theminute look at managed care in California's Medicaid (Medi-Cal) Program . Health Aff (Millwood) . 1996;;15:178-179.
32 +
Rowland D.  Medicaid managed care: state experiences . Bull N Y Acad Med . 1996;;73( (winter suppl) ):496-505.
33 +
Short PF, Cantor J, Monheit A.  The dynamics of Medicaid enrollment . Inquiry . 1998;;25:504-516.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
US Dept of Health and Human Services. 1996 Medicaid Managed Care Enrollment Report, Office of Managed Care, HCFA, June 1996 . Washington, DC: US Dept of Health and Human Services; 1996;.
2 +
Freund DA, Hurley RE.  Medicaid managed care: contribution to issues of health reform . Annu Rev Public Health . 1995;;16:473-495.
3 +
Rowland D, Hanson K.  Medicaid: moving to managed care: a quick summary of Medicaid managed care trends: the numbers, the models, the waivers . Health Aff (Millwood) . 1996;;15:150-152.
4 +
Sparer MS.  Medicaid managed care and the health reform debate: lessons from New York and California . J Health Polit Policy Law . 1996;;21:433-460.
5 +
The Medicaid Access Study Group.  Access of Medicaid recipients to outpatient care . N Engl J Med . 1994;;330:1426-1430.
6 +
Rowland D, Salganicoff A.  Controversy: lessons from Medicaid—improving access to office-based physician care for the low-income population . Am J Public Health . 1994;;84:550-552.
7 +
Perloff JD, Kletke PR, Fossett JW, Banks S.  Medicaid participation among urban primary care physicians . Med Care . 1997;;35:142-157.
8 +
Fossett JW, Peterson J.  Physician supply and Medicaid participation . Med Care . 1989;;27:386-396.
9 +
Sloan FA, Cromwell J, Mitchell J. Private Physicians and Public Programs . Lexington, Ky: DC Health; 1978;.
10 +
Landon BE, Tobias C, Epstein AM. Quality management by state Medicaid agencies converting to managed care: plans and current practice. JAMA. In press.
11 +
Rosenbaum S, Shin P, Smith BM, et al. Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts . Washington, DC: The George Washington University Medical Center for Health Policy Research; February 1997;.
12 +
National Academy for State Health Policy. Report to the Health Care Financing Administrator: Observations on the QARI Demonstration Project and Its Relation to Future Policy for Medicaid Managed Care . Portland, Me: National Academy for State Health Policy; May 15, 1995;.
13 +
Gold M, Felt S.  Reconciling practice and theory: challenges in monitoring Medicaid managed care quality . Health Care Financing Rev . 1995;;16:85-105.
14 +
Felt-Lisk S, St. Peter R. The Quality Assurance Reform Initiative (QARI) Demonstration for Medicaid Managed Care Final Evaluation Report, I: Summary Report . Washington, DC: Mathematica Policy Research Inc; September 1997;.
15 +
Horvath J, Kaye N, Pernice C, Snow KI. Medicaid Managed Care: A Guide for the States, I: State by State Current Medicaid Managed Care Program Scope and Operations . 3rd ed. Portland, Me: The National Academy for State Health Policy; January 1997;.
16 +
McNeil BJ, Pedersen SH, Gatsonis C.  Current issues in profiling quality of care . Inquiry . 1993;;329:1263-1265.
17 +
Jost TS.  Health system reform: forward or backward with quality oversight . JAMA . 1994;;271:1508-1511.
18 +
Kassirer JP.  The use and abuse of practice profiles . N Engl J Med . 1994;;330:634-636.
19 +
Pear R.  Florida's struggle to lift burden of Medicaid serves as model, and warning . New York Times . (April 24) ,1995;;section A:12.
20 +
General Accounting Office. Medicaid: States'Efforts to Educate and Enroll Beneficiaries in Managed Care . Washington, DC: General Accounting Office; September 17, 1996;. Report HEHS-96-184.
21 +
Epstein AM.  Performance reports on quality: prototypes, problems and prospects . N Engl J Med . 1995;;333:57-61.
22 +
Gold M, Sparer M, Chu K.  Medicaid managed care: lessons from five states . Health Aff (Millwood) . 1996;;15:153-166.
23 +
Liska D. Medicaid: Overview of a Complex Program . Washington, DC: The Urban Institute; May 1997;:1-5. Series A, No. A-8.
24 +
Kronick R, Zhou Z, Dreyfuss T.  Making risk adjustment work for everyone . Inquiry . 1995;;32:41-55.
25 +
Kronick R, Dreyfus T, Lee L, Zhou Z.  Diagnostic risk adjustment for Medicaid: the disability payment system . Health Care Financing Rev . (Spring) 1996;;17(3):7-33.
26 +
General Accounting Office. Report Cards: A Useful Concept but Significant Issues Need to Be Addressed . Washington, DC: General Accounting Office; 1994;.
27 +
The Kaiser Family Foundation and the Agency for Health Care Policy and Research. Americans as Health Care Consumers: The Role of Quality Information . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; October 1996;.
28 +
Mathematica Policy Research Inc. Experience in Collecting Selected HEDIS 2.0 Measures in the Medicaid Population . Palo Alto, Calif: The Kaiser Family Foundation; 1995;.
29 +
Henderson T, Markus AR.  Medicaid managed care: how do community health centers fit? Health Care Financing Rev . 1995;;17:135-142.
30 +
Iglehart JK.  Health policy report: Medicaid and managed care . N Engl J Med . 1995;;332:1727-1731.
31 +
Yokoi B.  A California analyst on Medicaid managed care: an up-to-theminute look at managed care in California's Medicaid (Medi-Cal) Program . Health Aff (Millwood) . 1996;;15:178-179.
32 +
Rowland D.  Medicaid managed care: state experiences . Bull N Y Acad Med . 1996;;73( (winter suppl) ):496-505.
33 +
Short PF, Cantor J, Monheit A.  The dynamics of Medicaid enrollment . Inquiry . 1998;;25:504-516.

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