Use Of Preventive Services By Managed Care Enrollees: An Updated Perspective

PROLOGUE: Proponents of managed care often tout the ability of managed care plans to coordinate patient care, including the screenings, counseling, and immunizations that constitute preventive care. Consumers seem to be increasingly distrustful of managed care plans in general, though, and annual Kaiser Family Foundation/Harvard University polls since 1997 have found a declining percentage of respondents agreeing that managed care plans “make it easier to get preventive services” ( www.kff.org/content/1999/1500 ). The authors of this paper conducted an extensive literature review, compiling and analyzing data across the U.S. health care system, to determine whether managed care plans are living up to their claims of providing superior levels of preventive care. Kathryn Phillips is an associate professor of health economics and health services research in the Department of Clinical Pharmacy, Institute for Health Policy Studies, and Prevention Sciences Group, University of California, San Francisco (UCSF). Susan Fernyak is the director of the Communicable Disease Prevention Unit, San Francisco Department of Public Health. Arnold Potosky is an operations research analyst in the Division of Cancer Prevention and Control, National Cancer Institute. Helen Halpin Schauffler is an associate professor of health policy and director of the Center for Health and Public Policy Studies at the University of California, Berkeley, School of Public Health. Melanie Egorin is a doctoral student in the sociology program at UCSF. ABSTRACT: We examined whether enrollees in managed care plans received more preventive services than enrollees in non–managed care plans did, by conducting an updated literature synthesis of studies published between 1990 and 1998. We found that 37 percent of comparisons indicated that managed care enrollees were significantly more likely to obtain preventive services; 3 percent indicated that they were significantly less likely to do so; and 60 percent found no difference. Enrollees in group/staff-model health maintenance organizations (HMOs) were more likely to receive preventive services, but there was little evidence, outside of Medicaid managed care, that managed care plans are worse at providing preventive services. However, most of the evidence is equivocal: Provision of preventive services was neither better nor worse in managed versus non–managed care plans. Because of the blurred distinctions among types of health plans, more research is needed to identify which plan characteristics are most likely to encourage appropriate utilization.