Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: We agree with Drs Somers and Baron
and with Ms O'Kane that there is a need for comparison of care received in
traditional fee for service Medicaid plans and Medicaid managed care delivery,
and stated this in our article. Indeed, comparisons of all components of our
health care delivery system are warranted. Our project examined quality delivered
to children in 2 components of our complex system—commercial and Medicaid
systems of managed care.
Disparities in social and family resources, economic standing, and basic
health unfortunately do exist between children privately insured and those
served by Medicaid programs. However, managed care organizations (MCOs) agree
to provide care to groups of enrollees as they exist, not in an idealized
or optimal setting. Information regarding these general socioeconomic differences
is obviously known and available to MCOs when contracting with states to provide
care to children in Medicaid programs. We are not aware of any contractual
caveats that excuse them from providing high quality of care to Medicaid enrollees
comparable to that received by children in commercial managed care plans.
Thompson JW, Ryan KW, Bost JE. Quality of Care in Medicaid Managed Care vs Commercial Managed Care Plans—Reply. JAMA. 2004;291(10):1195-1197. doi:10.1001/jama.291.10.1196-c