Growing neglect of American children.

Abstract

I read with interest the article by Maurer 1 in the May 1993 issue of AJDC. He is correct in acknowledging the deepening health care crisis for children in poverty. However, he is overly confident, I fear, that Medicaid managed care contracting will improve access to care for those children. Studies of pediatric managed care programs are few and not positive. A recent survey of American Academy of Pediatrics fellows indicated that managed care systems often restrict referrals to pediatric subspecialty and inpatient care, with compromised care reported by one third of the pediatricians. 2 There are also few studies of Medicaid managed care systems, and they too are not positive. One study done under the aegis of the Children's Defense Fund in 1988 concluded that these plans may exacerbate preexisting problems, such as underfunding and inadequate services to patients. 3 What is needed in Medicaid managed care is physician,