Managed care may not reduce access to healthcare

April 01, 2001

Contrary to previous study findings, a study of children in Maryland found an increase in managed care did not result in more cases of ruptured -- as opposed to simple - appendicitis, suggesting managed care may not reduce access to healthcare.

Previous studies have suggested that ruptured appendicitis among children is a useful marker for access to care and quality of care.

"The stability of the incidence of ruptured appendicitis in this study is reassuring," says study author Anne Gadomski, M.D., M.P.H., a research scientist and attending pediatrician at the Bassett Research Institute in Cooperstown, NY.

Studies have also found factors associated with managed care, including "gatekeeping" which can delay referrals for surgery, raise the risk of ruptured appendicitis in adults. Ruptured appendicitis is more likely to occur when treatment for appendicitis is delayed.

Using a combination of hospital discharge data and Medicaid claim forms, Gadomski and co-author Peter Jenkins, Ph.D., a statistician at the Bassett Research Institute, analyzed approximately five years of data from the state of Maryland, during which time 5,141 children were hospitalized with appendicitis. Also during this period, a fee-for-service Medicaid managed care program was instituted in Maryland.

Gadomski and Jenkins found no association between insurance type, such as managed care or private coverage, and the incidence of ruptured appendicitis. The study results are published in the April 2001 issue of the journal Health Services Research.

The researchers also noted that children who made more visits to the doctor for preventive care appeared to be at lower risk for ruptured appendicitis. "This finding may reflect a relationship with a primary care provider who can facilitate access and expedite referral. Or it may reflect parental attentiveness to health care issues," says Gadomski.

Although this study demonstrated a clear association between increased managed care and unaltered incidence rates, it does not prove that the stability of ruptured appendicitis rates was the result of this increase, say Gadomski and Jenkins.

The researchers suggest that further research is needed in states with more managed care programs, and that comparisons are needed among healthcare systems of varying quality.
This research was funded by the Health Care Financing Administration. Health Services Research is the bimonthly peer-reviewed journal of the Association for Health Services Research and is owned by Health Research and Educational Trust. For information about the journal, contact Alice Schaller at 510-643-5439 or email

Posted by the Center for the Advancement of Health For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!,

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