Résumé :
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[BDSP. Notice produite par INIST-CNRS R0x4hGfl. Diffusion soumise à autorisation]. Context 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. Objective 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 rates. Results 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<. lower rates than commercial plans for clinical quality indicators childhood immunization of vs access well-child visits in the first months life and common procedures myringotomies children aged years per members conversely some demonstrated equal high-quality care both populations. regression models failed to identify consistent plan characteristics that explained observed differences care. conclusions most health do not deliver on a number performance enrolled medicaid. policy makers public need plan-specific information inform purchasing decisions.>
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