Publication: Children and Managed Health Care

• Behrman, Richard E.

This issue of the journal focuses on how children are
affected by the adoption of managed health care as the
primary method for financing and delivering health care
services in the United States. Managed care has rapidly
transformed our previous high-cost, unmanaged health care
system based on consumer choice of providers into a
lower-cost, managed health care system in which consumer
choice is limited, access to health care services is more
tightly controlled, and financial risk is shared among
physicians, health plans, and other health care providers.
The enrollment of children in managed care has accelerated
in recent years as managed care plans attract more healthy
young families and as state Medicaid programs increasingly
require beneficiaries, primarily women and children, to
enroll in managed care plans.

The articles in this journal issue (1) describe managed
care trends and how incentives created by managed care may
affect children; (2) analyze legislation that is focused on
managed care organizations; and (3) examine empirical
evidence identifying the impact of managed care
arrangements on health care access, utilization, and
quality for children. Although data to evaluate the impact
of recent managed care trends are limited, several
important conclusions can be drawn from these articles.
First, the enrollment of children in managed care plans has
outpaced that of adults, and children are now
disproportionately represented among all managed care
members. The unique needs of children, however, have not
been considered in the development of managed care models.
Second, participation in managed care may be deleterious to
our most vulnerable children. The evidence suggests that
participation in managed care has decreased access to
preventive health services for poor children enrolled in
Medicaid and has reduced specialty care for children with
chronic or disabling conditions. Finally, although the
features of managed care offer many new opportunities to
improve the delivery, quality, and financing of children's
health care services, these opportunities have not been
seized upon by most managed care organizations. The
continued development of new managed care models offers
further opportunity to create a managed care system that
works for children. Features of this system are discussed
within the Analysis and Recommendations.