Managed care organizational characteristics and health care use among children with special health care needs.

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.