EEHSR Project 1: Managed Care and Persons with Musculoskeletal Conditions The share of private and public health insurance beneficiaries in managed care plans has substantially increased during the past decade. The literature concerning the impact of managed care on persons with musculoskeletal conditions is relatively small, and most of these studies compare fee-for-service and pre-paid group practice settings. The proposed project will evaluate the impact of the fastest growing forms of managed care on persons with musculoskeletal conditions, including independent practice associations, or IPAs, a form of HOMO; preferred provider organizations, or PPOs; and point of service plans. In addition, the project will evaluate some of the specific mechanisms various forms of managed care organizations use to manage care, including the use of closed panels of physicians, a gatekeeper to limit access to specialists and limited drug formularies.
The specific aims of the project are to describe the health plans of persons with musculoskeletal conditions through time and then determine if there are systematic differences in treatments, satisfaction, costs, and outcomes of care for those in fee-for service and different forms of managed care. The project will use the Medical Expenditures Panel Survey, a probability sample of 24,000 persons a year, to determine the impact of managed care on persons with all forms of musculoskeletal conditions in the nation as a whole. In addition, the project will use the UCSF RN Panel, consisting of 650 persons with rheumatoid arthritis from a random sample of Norther California rheumatologists, to ascertain the impact of managed care among individuals with a discrete rheumatic disease in an area with high market penetration by managed care plans. The information from the proposed project should prove useful to individual with high market penetration by managed care plans. The information from the proposed project should prove useful to individuals with musculoskeletal conditions in choosing plans, and to policy-makers concerned about the impact of managed care on those with discrete chronic conditions.
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