Landon B E, Tobias C, Epstein A M
Brigham and Women's Hospital, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
JAMA. 1998 Jan 21;279(3):211-6. doi: 10.1001/jama.279.3.211.
Enrollment in Medicaid managed care plans has increased more than 5-fold in this decade, but how states monitor and encourage quality of care in these programs is not known.
To characterize the quality monitoring and assurance activities of state Medicaid agencies for Medicaid beneficiaries enrolled in comprehensive prepaid managed care programs.
Structured telephone survey conducted between October 1996 and January 1997.
State Medicaid agencies.
Representatives from all state Medicaid agencies, including the District of Columbia, with beneficiaries enrolled in comprehensive prepaid managed care plans as of July 1, 1996.
Proportion of states with specific quality monitoring and assurance activities for Medicaid managed care.
We surveyed all 34 states enrolling beneficiaries in comprehensive managed care programs. In 1996, all 34 states enrolled the population receiving assistance from the Aid to Families With Dependent Children (AFDC) program, while only 21 (62%) and 15 (44%) enrolled the disabled and elderly populations, respectively. In the period 1995 to 1996, 19 states (63%) collected data on satisfaction with care, and 25 states (83%) collected data on childhood immunizations. No more than half of the states collected data on other selected measures of access and quality, but a substantial number planned to collect such data in 1997. While at most 37% of states were providing comparative data to health plans, up to 80% were planning to provide such information in 1997. Similarly, while at most 10% of states provided beneficiaries with such information, up to 38% planned to do so in 1997. The breadth of contracting requirements designed to assure quality varied substantially across states.
State Medicaid agencies have already begun adapting to their new roles as purchasers of health care. Continued monitoring is essential to ensure that state agencies implement planned programs and that quality of care for Medicaid enrollees is preserved or improved.
本十年中，医疗补助管理式医疗计划的参保人数增长了5倍多，但各州如何监测和促进这些计划中的医疗质量尚不清楚。
描述各州医疗补助机构针对参加综合预付管理式医疗计划的医疗补助受益人的质量监测和保障活动。
1996年10月至1997年1月进行的结构化电话调查。
各州医疗补助机构。
所有州医疗补助机构的代表，包括哥伦比亚特区，截至1996年7月1日，其受益人参加了综合预付管理式医疗计划。
对医疗补助管理式医疗开展特定质量监测和保障活动的州的比例。
我们调查了所有34个为受益人登记综合管理式医疗计划的州。1996年，所有34个州都为领取抚养子女家庭援助（AFDC）计划援助的人群进行了登记，而只有21个州（62%）和15个州（44%）分别为残疾人和老年人进行了登记。在1995年至1996年期间，19个州（63%）收集了对医疗服务满意度的数据，25个州（83%）收集了儿童免疫接种的数据。对于其他选定的可及性和质量指标，收集数据的州不超过半数，但相当多的州计划在1997年收集此类数据。虽然最多37%的州向健康计划提供比较数据，但高达80%的州计划在1997年提供此类信息。同样，虽然最多10%的州向受益人提供此类信息，但高达38%的州计划在1997年这样做。为确保质量而制定的合同要求的广度在各州之间差异很大。
各州医疗补助机构已经开始适应其作为医疗保健购买者的新角色。持续监测对于确保州机构实施计划中的项目以及维持或提高医疗补助参保人的医疗质量至关重要。
