Health policy and ethics forum: Managed care plan performance since 1980: Another look at 2 literature reviews

Abstract

Objectives. This article compares the quality of care provided by managed care plans (MCPs) and indemnity (or fee-for-service [FFS]) plans since 1980. Methods. The 44 studies examined are the studies that Miller and Luft cited in their 1994 and 1997 reviews of the literature comparing MCPs with FFS plans. These studies are examined to determine how well they met Miller and Luft's selection criteria and, in addition, whether they controlled for differences in the breadth of insurance coverage. Results. The 44 studies generated 57 observations. MCPs scored better than FFS plans on 10 of these, equally well on 25, and worse on 22. However, only 44 of these observations met the Miller-Luft criteria plus the coverage criterion. Four of these indicated that MCP care was better, 19 that MCP and FFS care were equivalent, and 21 that MCP care was worse. Conclusions. The small body of reliable studies comparing the quality of MCP care with that FFS care indicates that the quality of care provided by MCPs tends to be equal or inferior to that provided by FFS plans.