For-profit and not-for-profit health plans participating in Medicaid

The proliferation of for-profit health plans has heightened concerns about quality of care, particularly with respect to Medicaid. We undertook this s tudy to compare for-profit and not-for-profit health plans that participate in Medicaid, examining processes of care and the organizational characteri stics related to utilization management, financial incentives, and quality of care. Our findings demonstrate that for-profit and not-for-profit plans appear to be more similar than dissimilar in many areas of management, alth ough for-profit plans are more likely to use aggressive utilization review and have slightly less developed quality management systems. On balance, th ese findings should reassure critics of for-profit health care.