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March 10, 2004

Quality of Care in Medicaid Managed Care vs Commercial Managed Care Plans

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(10):1195-1197. doi:10.1001/jama.291.10.1196-a

To the Editor: I have 2 concerns about the article by Dr Thompson and colleagues.1 First, the rates of compliance with the quality measurements were very low in children with both Medicaid managed care and commercial managed care. For instance, the authors found a vaccination rate of 69% for the patients in commercial plans, well below the stated national target of 90%, which has not been changed since originally set by the US Public Health Service.2 If the authors had examined a commercially insured population with higher overall rates of childhood vaccination, the results for children covered by Medicaid managed care might have been more similar. I am also concerned about their use of myringotomy tube placement as a reflection of the care of the managed care plan or of the primary care physician. These measures are also influenced by whether the specialist treats the Medicaid and non-Medicaid patients similarly.

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