THE EFFECT OF MANAGED CARE ON QUALITY - A REVIEW OF RECENT-EVIDENCE

This article reviews recent evidence about the relationship between ma naged care and quality. With one exception, the studies reviewed repre sent observation periods that extend through 1990 or a more recent yea r. The review has led to the conclusion that managed care has not decr eased the overall effectiveness of care. However, evidence suggests th at managed care may adversely affect the health of some vulnerable sub populations. Evidence also suggests that enrollees in managed care pla ns are less satisfied with their care and have more problems accessing specialized services. In addition, younger, wealthier, and healthier persons were more satisfied with their health plans than older, poorer , and sicker persons, even after adjusting for the type of health plan . The findings of the studies reviewed do not provide definitive resul ts about the effect of managed care on quality. Indeed, relatively few studies include data from the 1990s, and little is known about the ne wer types of health maintenance organizations that invest heavily in i nformation systems and rely on financial incentives to alter practice patterns. Furthermore, managed care is not a uniform method that is ap plied identically by all health plans, and research studying the dimen sions of managed care also is needed.