Health Care Costs and Financing

Inner-city parents often have limited knowledge about managed care rules and practices

More than half (58 percent) of Americans insured by State Medicaid programs are enrolled in managed care plans. Yet, a survey of urban parents living in Boston found that most of them, especially those who are disadvantaged, do not know what managed care is and have little knowledge about managed care rules and practices. For example, many of the surveyed parents believed that prior approval was not necessary for emergency department visits for mild childhood illnesses.

These parents need better, more understandable information about managed care, particularly parents who are poor, Latino, and have limited English proficiency, suggests Glenn Flores, M.D., of Boston Medical Center. Dr. Flores and his colleagues interviewed 1,100 parents at inner-city community sites—including supermarkets, hair salons, and laundromats—about care access, insurance, and managed care. Their work was supported in part by the Agency for Healthcare Research and Quality (K02 HS11305).

Most of the parents were poor, minority, and covered by public health insurance. Although 55 percent of insured children were covered by managed care, 45 percent of their parents were unaware of their children's managed care coverage. When asked, "What is managed care?" 88 percent of parents did not know it was a type of insurance, and 94 percent did not identify a specific feature. Latino parents were significantly more likely to provide a wrong or "do not know" answer to this question.

Most parents reported that if their child were covered by managed care, they would bring the child to the ED without prior approval for minor childhood problems such as a sprained ankle or diarrhea. Latino ethnicity, having a child not covered by managed care, and having a child covered by managed care but being unaware of the managed care coverage were associated with 2.0, 2.3, and 2.9 greater odds, respectively, of answering definitions of managed care wrong or with a "don't know." Low family income and limited English proficiency were consistently associated with significantly higher odds of "wrong/do not know" answers about specific managed care features.

See "Urban parents' knowledge and practices regarding managed care," by Dr. Flores, Milagros Abreu, M.D., Donglin Sun, M.S., and Sandra C. Tomany, M.S., in the April 2004 Medical Care 42(4), pp. 336-345.

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