Managed Care Organizational Characteristics and Health Care Use among Children with Special Health Care Needs

Authors

  • Elizabeth Shenkman,

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    • Address correspondence to Elizabeth Shenkman, Ph.D., Director, Institute for Child Health Policy; 1329 SW 16th Street, Suite 5130, Gainesville, Florida 32608. Dr. Shenkman is also an Associate Professor at the University of Florida, College of Medicine, Department of Pediatrics and the Department of Health Policy and Epidemiology. Samuel S. Wu, Ph.D., is an Assistant Professor at the University of Florida, College of Medicine, Department of Statistics and Research Health Scientist, at the VA Rehabilitation Outcome Research Center of Excellence. John Nackashi, M.D., Ph.D., is a Professor and Division Chief, University of Florida, College of Medicine, Department of Pediatrics. James Sherman, M.D., is a Professor and Associate Chairman, University of Florida, College of Medicine, Department of Pediatrics.

  • Samuel S. Wu,

  • John Nackashi,

  • James Sherman


  • This work was funded by the Agency for Health Care Research and Quality, the American Association of Health Plans Foundation, and Health Resources and Services Administration grant no. U01 HS09949-02.

Abstract

Objective. To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.

Data Sources. Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data.

Study Design. Cross-sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee-for-Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.

Data Collection/Extraction Methods. The telephone and MCO-administrator survey data were linked to the enrollment and claims files.

Principal Findings. The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.

Conclusion. After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns.

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