Accountability in Medicaid Managed Care: Implications for Pediatric Health Care Quality

This study examines the structure and operation of Medicaid and State Children\u27s Health Insurance Program (SCHIP) health care access and quality monitoring systems for children enrolled in comprehensive managed care arrangements. As the single largest purchasers of pediatric health care in the U.S., Medicaid and SCHIP agencies play a potentially powerful role in pediatric health policy. How these agencies approach, design, and carry out health quality monitoring activities has the potential to have a major impact not only for poor and low-income children, but for the entire pediatric health system. Even when these systems are developed exclusively for publicly insured children, their influence can extend beyond the four corners of a specific contractual arrangement, since participating health professionals, health care institutions and businesses typically are not exclusive to these arrangements, and the devolutionary influence of one purchaser\u27s expectations thus can travel beyond the scope of the agreement