Diagnostic testing and return visits for acute problems in prepaid, case-managed Medicaid plans compared with fee-for-service.

Enrollment of Medicaid recipients into capitated, case-managed systems of health care has been advocated as a means to control costs. We studied the effect of such systems on care for urinary tract infection (UTI), pelvic inflammatory disease, and vaginitis among women enrolled in Aid to Families with Dependent Children in capitated demonstration programs in Santa Barbara County, California, and Jackson County, Missouri (prepaid), compared with similar but fee-for-service (FFS) counties in Ventura County, California, and St Louis, Mo. Structured abstracts were performed on 2382 outpatient charts with one of the three conditions in 1985. The proportion of cases with UTI in which a urine culture was obtained was similar in Santa Barbara (prepaid) and Ventura (FFS), 47% vs 46%, but greater in Jackson County (prepaid) than St Louis (FFS), 58% vs 32%. The proportion of cases with return visits for a UTI was: Santa Barbara (prepaid), 40%; Ventura (FFS), 33%; Jackson (prepaid), 72%; and St Louis (FFS), 53%. The proportion of patients with pelvic inflammatory disease with cervical cultures for gonorrhea as Santa Barbara (prepaid), 81%; Ventura (FFS), 52%; Jackson (prepaid), 86%; and St Louis (FFS), 61%. The proportion of women returning for follow-up after pelvic inflammatory disease was similar across all counties at 40% and 50%. The number of office diagnostic tests performed for vaginitis was greater in both demonstration counties. These data do not demonstrate any diminution in either diagnostic testing or follow-up visits for three common ambulatory problems in a Medicaid population enrolled in a capitated, case-managed system, with some trends for more care in the demonstration sites.