The Effect of Managed Care on Quality

Abstract

This article reviews recent evidence about the relationship between managed care and quality. With one exception, the studies reviewed represent observation periods that extend through 1990 or a more recent year. The review has led to the conclusion that managed care has not decreased the overall effectiveness of care. However, evidence suggests that managed care may adversely affect the health of some vulnerable subpopulations. Evidence also suggests that enrollees in managed care plans are less satisfied with their care and have more problems accessing specialized services. In addition, younger, wealthier, and healthier persons were more satisfied with their health plans than older, poorer, and sicker persons, even after adjusting for the type of health plan.The findings of the studies reviewed do not provide definitive results about the effect of managed care on quality. Indeed, relatively few studies include data from the 1990s, and little is known about the newer types of health maintenance organizations that invest heavily in information systems and rely on financial incentives to alter practice patterns. Furthermore, managed care is not a uniform method that is applied identically by all health plans, and research studying the different dimensions of managed care also is needed.Arch Intern Med. 1998;158:833-841 In their 1994 review of managed care plan performance, Miller and Luft determined that: "The HMO [health maintenance organization] and indemnity plans provided enrollees with roughly comparable quality care, according to process or outcomes measures." 1(p1516) They also determined that HMO enrollees were less satisfied with their care than enrollees in indemnity plans.Miller and Luft 1 reviewed studies published before 1994. Yet, many important studies of the effect of managed care on quality have become available since that time. 2-9

Type of health insurance and the quality of primary care experience

“…Similarly, this study examined HMO vs FFS rather than the distinguishing attributes of managed care, including gatekeeping arrangements, provider and patient financial inducements, restricted provider networks, and limited choice of health care services. 27 Future studies can identify which managed care attributes foster or impede primary care performance.…”

“…Understanding the type of insurance coverage most associated with high-quality primary care is critical to policymakers who must justify the appropriate mix of public vs private approaches and the level of managed care involvement in the face of a managed care backlash. [26][27][28] Knowledge of the impact of insurance on the quality of primary care will broaden our understanding of access issues and contribute to policies that improve access.…”

Effects of health insurance and race on colorectal cancer treatments and outcomes

“…17 Health insurance has been suspected of influencing the type of health care that patients receive. 18 Few studies, however, have examined the effects of insurance payer on colorectal cancer care. Studies have found no difference in treatments or outcomes between fee-forservice (FFS) and HMO insurance types, but most studies have not been population based.…”

Low-mortality death in hospitals after vertical integration with Health Maintenance Organizations

“…[23,24] Studies used multivariate regression in HMO versus non-HMO hospitals over time to study quality of care indicators, rather than pre-and post-HMO merge data like we did. Within differing HMO plans, the literature suggests that investor-owned HMOs deliver lower quality of care than not-for-profit plans.…”