Differences in Health Care Quality for Children and Adults Under Managed Care: Justification for Separate Quality Assessments?

Abstract

To assess reported results of health care quality for children and adults in managed systems of care and to determine if variations exist between reported quality results for adults and children within the same plan. We utilized Consumer Assessment of Health Plan Survey results reported from 424 managed care plans to the National Committee for Quality Assurance in 1999. Responses from 218 530 adults (515 per plan, 424 plans) and 55 081 parents of children 0-12 years of age (304 per plan, 181 plans) were available. Restricting analyses to the 178 plans reporting both adult and child results, we performed matched-pairs analyses to test the hypothesis that child results would be the same as their adult counterparts within the same plan. Regression methods were employed to test for potential demographic differences explaining observed differences. Within the same plan, reported results for care provided by specialists and primary care physicians to adults and children in the same plan revealed marked variation, including rating of doctor (Spearman correlation coefficient, r(S) =.504) and rating of specialist (r(S) =.326). Conversely, assessments of activities related directly to health plan activities showed little variation, including rating of health plan (r(S) =.850) and claims processing (r(S) =.857). Differences in demographic characteristics between adults and child survey respondents do not appear to explain observed variations. Separate quality of care assessments for adults and children within the same managed care system identify significant differences in reported quality. Having health plan quality information about adult care does not serve as a proxy for needed information on children, particularly the care related to primary care and specialist providers. Areas of health plan assessment common to both adults and children (eg, claims processing) could be replaced with more targeted assessments of importance to parents and purchasers (eg, children with chronic conditions).