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Journal Issue: Children and Managed Health Care Volume 8 Number 2 Spring 1998

Statement of Purpose
Richard E. Behrman

Statement of Purpose

The primary purpose of The Future of Children is to disseminate timely information on major issues related to children's well-being, with special emphasis on providing objective analysis and evaluation, translating existing knowledge into effective programs and policies, and promoting constructive institutional change. In attempting to achieve these objectives, we are targeting a multidisciplinary audience of national leaders, including policymakers, practitioners, legislators, executives, and professionals in the public and private sectors. This publication is intended to complement, not duplicate, the kind of technical analysis found in academic journals and in the general coverage of children's issues by the popular press and special interest groups.

This issue of the journal focuses on how children are affected by the adoption of managed health care as the primary method for financing and delivering health care services in the United States. Managed care has rapidly transformed our previous high-cost, unmanaged health care system based on consumer choice of providers into a lower-cost, managed health care system in which consumer choice is limited, access to health care services is more tightly controlled, and financial risk is shared among physicians, health plans, and other health care providers. The enrollment of children in managed care has accelerated in recent years as managed care plans attract more healthy young families and as state Medicaid programs increasingly require beneficiaries, primarily women and children, to enroll in managed care plans.

The articles in this journal issue (1) describe managed care trends and how incentives created by managed care may affect children; (2) analyze legislation that is focused on managed care organizations; and (3) examine empirical evidence identifying the impact of managed care arrangements on health care access, utilization, and quality for children. Although data to evaluate the impact of recent managed care trends are limited, several important conclusions can be drawn from these articles. First, the enrollment of children in managed care plans has outpaced that of adults, and children are now disproportionately represented among all managed care members. The unique needs of children, however, have not been considered in the development of managed care models. Second, participation in managed care may be deleterious to our most vulnerable children. The evidence suggests that participation in managed care has decreased access to preventive health services for poor children enrolled in Medicaid and has reduced specialty care for children with chronic or disabling conditions. Finally, although the features of managed care offer many new opportunities to improve the delivery, quality, and financing of children's health care services, these opportunities have not been seized upon by most managed care organizations. The continued development of new managed care models offers further opportunity to create a managed care system that works for children. Features of this system are discussed within the Analysis and Recommendations.

We welcome your comments and suggestions regarding this issue of The Future of Children. Our intention is to encourage informed debate about managed health care. To this end we invite correspondence to the Editor. We would also appreciate your comments about the approach we have taken in presenting the focus topic and welcome your suggestions for future topics.