Do managed care plans' tiered networks lead to inequities in care for minority patients?

This study examined whether specialists designated as meeting efficiency thresholds in an insurance company's performance network were less likely than non-designated specialists to treat minority patients insured by that company. Claims data were used to identify patients treated by specialists. Claimants' race/ethnicity status was self-reported to the insurer at enrollment. In large part, minority patients appeared to be evenly distributed across the performance network, with the exception of Asian/Pacific Islanders, who appeared to be more likely to be treated by nondesignated physicians than by designated "good-performing" specialists.

The effect of consumer-directed health plans on the use of preventive and chronic illness services.

We compared use of preventive, cancer screening, and diabetic monitoring services among 17,411 people who were continuously enrolled in a consumer-directed health plan (CDHP) for three years with a matched group of 128,444 people who were enrolled in a preferred provider organization (PPO). In the CDHPs, preventive and screening services were free. Levels and trends in use were similar between the two groups over the three years of follow-up. These results support varying the degree of cost sharing for services depending on the effect of the service on future health status and costs.