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Article
Utilization of services by chronically ill people in managed care and indemnity plans: implications for quality
Women’s Health Research Faculty Publications
  • Stephen M Davidson
  • Harriet Davidson
  • Heidi Miracle-McMahill
  • J Michael Oakes
  • Sybil L. Crawford, University of Massachusetts Medical School
  • David Blumenthal
  • Daniel P Valentine
UMMS Affiliation
Department of Medicine, Division of Preventive and Behavioral Medicine
Date
7-3-2003
Document Type
Article
Subjects
Age Factors; Aged; Asthma; Chronic Disease; Diabetes Mellitus; Health Services Research; Heart Failure, Congestive; Hospitalization; Humans; Insurance, Health; Managed Care Programs; Medicare; Patient Acceptance of Health Care; Primary Health Care; Quality of Health Care; Referral and Consultation; Reimbursement, Incentive; *Utilization Review
Abstract
Because incentives for managed care organizations favor cost containment, concerns have been raised that quality of care has suffered, especially for chronically ill people. This study compares utilization rates of managed care and indemnity patients with three chronic conditions, using five years of claims records (1993-97) from private plans and Medicare in one market. Findings show that for all three conditions, managed care patients were more likely to see both primary care physicians and specialists within a year, but less likely to use a hospital emergency department or to be an inpatient. Assuming that patients with these illnesses should see a physician annually and that good primary care reduces the need for emergency and inpatient services, it appears that the patterns of care used by chronically ill managed care patients in this market do not reflect lower quality than that received by similar indemnity patients.
Rights and Permissions
Citation: Inquiry. 2003 Spring;40(1):57-70.
Related Resources
Link to article in PubMed
PubMed ID
12836908
Citation Information
Stephen M Davidson, Harriet Davidson, Heidi Miracle-McMahill, J Michael Oakes, et al.. "Utilization of services by chronically ill people in managed care and indemnity plans: implications for quality" Vol. 40 Iss. 1 (2003) ISSN: 0046-9580 (Print)
Available at: http://works.bepress.com/crawfords/31/