Lessons Learned From Medicaid Managed Care Approaches

Medicaid's Role in Moves Toward Universal Health Care

“…They can profit by selecting members who are healthy and need a minimum of care; they make losses by enrolling members whose health problems require considerable care. For that reason, most Medicaid recipients are relatively unattractive to commercial HMOs (Luft and Miller, 1988;Anderson and Fox, 1987). When Medicaid programs have contracted with managed care organiza tions, the HMOs have tended to recruit AFDC recipients who are relatively healthy and ignore SSI recipients whose health needs can be cxtrcme.…”

Privatization in Health Care: Shifting the Risk

“…In the public sector, managed care has become a popular way to control rising health care costs. More than 1.5 million people in 29 states and the District of Columbia were enrolled in Medicaid managed care systems as of June 1986 (Anderson and Fox 1987). State Medicaid managed care programs are primarily intended to reduce expenditures by controlling utilization (Prottas and Handler 1987).…”

“…In addition, the costs of administering the programs and performing utilization review and quality assurance are not negligible. Finally, there are factors that influence the willingness of established plans to participate in a Medicaid managed care program, including the competitive nature of the local market and the inducements offered by the states (Anderson and Fox 1987;Prottas and Handler 1987). Discussion ' In a sense, most recent attempts on the part of state Medicaid programs to reduce costs and encourage competition can be considered &dquo;managed care,&dquo; including the use of selective contracting, capitation payments, primary care case management, and medical case management.…”

“…Preliminary results indicate savings in the range of 2-5 percent, depending on the mix of programs (Freund and Neuschler 1986). Anderson and Fox (1987) note that state officials believe these programs offer predictable budgetary increases while promoting quality and continuity of care and that both consumers and providers appear comfortable with the concept.…”

Mandatory HMO Enrollment in Medicaid: The Issue of Freedom of Choice

“…In portions o f six other states, M edicaid beneficiaries are also re quired to enroll in H M O s. The M edicaid competition demonstration has sites in four states: Santa Barbara, California; Kansas City, M is souri; Monroe County, New York; and three counties in Minnesota (Hurley 1986 Anderson and Fox (1987) expect these programs to expand in the future.…”