MANAGED CARE AND THE QUALITY OF CHILDRENS HEALTH-SERVICES

Managed care has changed the practice of medicine. The choice of healt h care providers has been narrowed, physicians are being held financia lly accountable for the number of services they use, and a new emphasi s is being placed on the cost and quality of the care provided. The tr ansition to managed care has occurred with little attention to its imp act on access to health care services or the quality of services provi ded. There is an absence of information about how children fare in the se new systems. What little is known indicates that children in manage d care arrangements are less likely to be able to be seen by pediatric specialists, and that families and providers are less satisfied under managed care. The impact of these changes on children's health status , however, is yet to be determined. For children with special needs, t he problems of coordination of care, coverage of needed services, and the choice of the appropriate pediatric subspecialists, many of which existed in traditional fee-for-service systems, persist under managed care. In spite of all of the negative anecdotes about managed health c are, managed care's focus on its population of enrollees and its heigh tened sense of a need for health care accountability bring exciting ne w opportunities to measure and improve the health care children receiv e. A new emphasis is being placed on practicing evidence-based medicin e; the focus is on closing the gap between what is known (effective, e vidence-based care) and what is done (current practice). Improved heal th outcomes and reduced health care costs have been documented in demo nstration projects in neonatal intensive care units and in pediatric o ffices. Applying the principles of these learning collaboratives and e mploying the tools of continuous quality improvement in health care ar e urgent challenges that deserve to be met. Health plans, physicians, health care purchasers, regulators, families, and their children must work together to assure that children receive the highest-quality care possible-care that is technically excellent and medically appropriate , and that improves the health of our children.