Impact Of Managed Care On Pediatric Medicaid Patients

The study involved analyzing pediatric hospitalization data before and after the implementation of the Maryland Access to Care (MAC) Program, a fee-for-service managed care program which emphasized the establishment of a medical "home base" for Medicaid recipients. Each recipient chose (or was assigned to) a primary care provider who authorizes emergency, specialty or inpatient care. The MAC Program began in December 1991 for all adults and children insured by Medicaid in Maryland.

The researchers looked at five years of insurance claims (three years pre-MAC and two years post-MAC). They studied hospital admissions that were likely to have been avoided with improved preventive and primary care. Examples of these include hospital stays for conditions such as asthma, diabetes, bronchitis or gastroenteritis where the children did not receive sufficient outpatient care prior to the hospitalization.

By comparing data prior to and after implementation of the MAC Program, the researchers found that the number of outpatient pediatric visits increased 38 percent. Visits to the emergency department did not change. Children who used the MAC Program were less likely to be hospitalized for avoidable conditions than those not enrolled in the MAC Program. Children who received preventive care were less likely to be admitted for avoidable conditions. Children using the emergency room frequently were more likely to be hospitalized for avoidable conditions.

"These results are encouraging to pediatricians and others who care for children because they suggest that we can prevent certain hospitalizations when children receive regular primary and preventive health care. When routine health care and preventive measures are more accessible to children, hospital admission and costs are lower," said Anne M. Gadomski, M.D., M.P.H., Bassett Healthcare pediatrician/researcher and principal investigator for the study. Other Bassett researchers involved in the study were Melissa Nichols, M.S., and biostatistician Paul Jenkins, Ph.D.

The researchers presented the findings at the 1997 annual meeting of the Pediatric Academic Societies held in Washington DC May 2-6, 1997. The abstract was also published in a special issue of Ambulatory Child Health.