You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 147 No. 5, May 1993 TABLE OF CONTENTS
  Archives
  •  Online Features
  ARTICLE
 This Article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal

Health maintenance organizations and children with special health needs. A suitable match?

H. B. Fox, L. B. Wicks and P. W. Newacheck
Fox Health Policy Consultants, Washington, DC 20036.

OBJECTIVE--To address how well health maintenance organizations (HMOs) meet the needs of almost 700,000 children with disabilities due to chronic conditions enrolled in these plans. DESIGN--A cross-sectional survey. MEASUREMENTS/MAIN RESULTS--Health maintenance organizations offered better protection than conventional plans against out-of-pocket expenses and were much more likely than fee-for-service plans to cover ancillary therapies, home care, outpatient mental health care, and medical case management. In addition, few HMOs maintained exclusions for preexisting conditions. Other aspects of HMO policies, however, were found to operate against the interest of families with chronically ill children. In particular, HMOs commonly made specialty services available only when significant improvement was expected within a short period. Also, HMOs typically placed limits on the amount and duration of mental health, ancillary services, and certain other services frequently needed by chronically ill children. Probably the most serious problems for chronically ill children enrolled in HMOs were the lack of choice among and access to appropriate specialty providers. PARTICIPANTS--Individual HMO plans. SELECTION PROCEDURE--A sample of 95 geographically representative HMOs were selected; 59 (62%) responded. INTERVENTIONS--None. CONCLUSIONS--Health maintenance organizations offer several advantages over traditional fee-for-service plans for families whose children have special health needs. However, the results also indicate that HMOs do not always operate effectively as service provision systems for these children. To a large extent, the availability and quality of services available to a child with special needs is likely to depend on the parents' ability to maneuver within the system.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Children With Special Health Care Needs Enrolled in the State Children's Health Insurance Program (SCHIP): Patient Characteristics and Health Care Needs
Szilagyi et al.
Pediatrics 2003;112:e508-520.
ABSTRACT | FULL TEXT  

Utilization of Medical and Health-Related Services Among School-Age Children and Adolescents With Special Health Care Needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data)
Weller et al.
Pediatrics 2003;112:593-603.
ABSTRACT | FULL TEXT  

Impact of the Oregon Health Plan on Children With Special Health Care Needs
Mitchell et al.
Pediatrics 2001;107:736-743.
ABSTRACT | FULL TEXT  

The Adult With Cerebral Palsy
Rapp and Torres
Arch Fam Med 2000;9:466-472.
ABSTRACT | FULL TEXT  

Access to Health Care for Children With Special Health Care Needs
Newacheck et al.
Pediatrics 2000;105:760-766.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1993 American Medical Association. All Rights Reserved.