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To the Editor: Dr Thompson and colleagues¹ found that Medicaid managed care plans for children and adolescents had lower scores for quality indicators (including rates of immunization, well-child visits, and myringotomy and tonsillectomy) than did commercial managed care plans. As the authors pointed out, characteristics of children enrolled in Medicaid plans are likely to be different from those of children in commercial plans. For instance, we suspect that there are underlying disparities in quality of housing and access to education, as well as in parents' occupational, marital, and health status. We agree that such inequalities are unacceptable in a just society and that policymakers and public purchasers should struggle to close those gaps. In the face of these underlying disparities, however, we would not assume that simply moving to a managed care model would overcome diffrences in health care access, utilization, or outcomes for children.

Thus, we do not think . . . [Full Text of this Article]

Stephen Somers, PhD
Center for Health Care Strategies
Princeton, NJ

Richard J. Baron, MD
Healthier Babies, Healthier Futures Inc
Philadelphia, Pa

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