Women's health and managed care: Promises and challenges

Abstract

T his is an appropriate time to examine women’s health and managed care. With the rapid growth of managed care in today’s health care delivery system, managed care organizations are playing an increasingly important role in the health of women. As managed care quickly becomes the dominant source of health care delivery for women in both the public and private sectors, understanding its impact on the health of women is crucial. It is increasingly difficult to define what the term managed care means. According to the Congressional Budget Office, managed care encompasses a broad range of health care organizational arrangements that are intended to eliminate unnecessary and inappropriate care and to reduce costs.’ The spectrum of managed care includes tightly structured group and staff model health maintenance organizations (HMOs), more loosely structured network and preferred provider organization (PPO) models, and various hybrid products such as point of service (POS) arrangements. Although comparisons of the different models are limited, it is likely that each model will vary with respect to patient care, satisfaction, and costs. Managed care plans now finance care for more than half of privately insured individuals, 9% of Medicare beneficiaries, and 23% of Medicaid beneficiaries.2A The most rapid enrollment growth, particularly among the privately insured population, is occurring among the less-structured managed care arrangements. The number of enrollees in network and independent practice association (IPA) arrangements increased from 19 million in 1988 to 35 million in 1994, whereas group/staff HMO enrollment grew from 14 million to 16 million over the same period.’ The managed care industry also is characterized increasingly by for-profit health plans. More than half of managed care enrollees (58%) were in for-profit plans in 1994, compared with one-quarter in 1985.6 Given this changing managed care environment, there are many unknowns with respect to changes in access to and quality of patient care as well as health care costs.7 Studies are just beginning to provide information on how these different plans perform. This paper examines the impact that managed care is having on privately o 1996 by x-he Jacobs Institute insured women and on low-income women with Medicaid coverage. To unof Women’s Health derstand managed care’s effect on women with private insurance, an analysis Published by Elsevier Science Inc