State regulation of managed care: The impact on children

Research output: Contribution to journalArticle

Abstract

As more and more children enroll in managed care, states have responded to concerns expressed by their constituents by passing legislation and developing credentialing requirements to assist families with children in receiving appropriate care from managed care plans. Although most of the legislation and credentialing requirements apply to the population generally, a few provisions apply specifically to children. The legislation and credentialing requirements attempt to improve both access to medical care and the quality of care by enacting access-to-care and quality-of-care provisions, reducing the financial incentives for providers to offer inappropriate care, and providing families with more information about their choices and opportunities to redress their grievances. Although there is no empirical evidence, analysis of similar types of legislation suggests that certain approaches will be more successful than others; one obvious indicator of success is the ability of the regulatory agency to develop clear, unambiguous, enforceable rules. Existing legislation varies widely across states in terms of the issues addressed and the specificity of the laws. For the most part, this legislation has been piecemeal, addressing specific issues as they arise. In the long run, state legislatures may not have the time or the expertise to regulate the managed care industry, and other regulatory bodies may be better equipped to address concerns about managed care. If utilized, however, existing regulatory bodies, which historically monitored fee-for-service medicine, will need to be redesigned to monitor managed care.

Original languageEnglish (US)
Pages (from-to)76-92
Number of pages17
JournalFuture of Children
Volume8
Issue number2
StatePublished - Jun 1998

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Managed Care Programs
Legislation
managed care
legislation
Credentialing
regulation
Quality of Health Care
Fee-for-Service Plans
Aptitude
fee
medical care
Motivation
Industry
expertise
incentive
Medicine
medicine
Law
industry
ability

ASJC Scopus subject areas

  • Social Sciences (miscellaneous)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)
  • Social Sciences(all)

Cite this

State regulation of managed care : The impact on children. / Anderson, Gerard F.

In: Future of Children, Vol. 8, No. 2, 06.1998, p. 76-92.

Research output: Contribution to journalArticle

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