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To the Editor: Dr Thompson and colleagues¹ reported that the quality of care delivered to children enrolled in Medicaid health plans compared unfavorably to the care delivered to the commercially insured. This comparison, however, ignores the striking differences in socioeconomic status between children covered by commercial vs Medicaid plans, which appears to be responsible for most of the disparities in access and quality of care.²

It would have been more useful to ask how quality of care differs between Medicaid managed care enrollees vs those receiving traditional Medicaid. States turned to managed care for Medicaid recipients to address both the rising costs of health care and problems in fragmentation of care. Evaluations of Medicaid managed care plans compared with traditional Medicaid coverage have historically shown positive effects such as improved access to primary care services.³ Good evidence comparing performance on clinical quality of care measures for managed care plans vs . . . [Full Text of this Article]

Margaret E. O'Kane, MHS
National Committee for Quality Assurance
Washington, DC

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