For-profit and not-for-profit health plans participating in Medicaid |
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Authors: | Landon B E Epstein A M |
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Affiliation: | Harvard Medical School and Beth Israel Deaconess Medical Center, USA. |
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Abstract: | The proliferation of for-profit health plans has heightened concerns about quality of care, particularly with respect to Medicaid. We undertook this study to compare for-profit and not-for-profit health plans that participate in Medicaid, examining processes of care and the organizational characteristics related to utilization management, financial incentives, and quality of care. Our findings demonstrate that for-profit and not-for-profit plans appear to be more similar than dissimilar in many areas of management, although for-profit plans are more likely to use aggressive utilization review and have slightly less developed quality management systems. On balance, these findings should reassure critics of for-profit health care. |
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