Objectives: To estimate the proportion of persons with rheumatoid arthritis (RA) in managed care and fee-for-service settings in 1994 and 1999, to ascertain whether there are differences in utilization between persons in the 2 systems of care in the 2 years, and to determine whether 1994 managed care status or change between 1994 and 1999 in managed care status affects outcomes.
Methods: The present study uses data from the University of California, San Francisco RA Panel Study, in which 310 patients with RA from a random sample of Northern California rheumatologists were interviewed annually between 1994 and 1999 using a structured survey instrument. We use linear and logistic regression to compare the health care utilization and outcomes of persons in managed care and fee-for-service after adjusting for differences in demographic and health characteristics.
Results: The proportion of respondents in managed care increased from 60% to 79% between 1994 and 1999, including an increase from 37% to 68% among persons eligible for Medicare and an increase from 74% to 92% among persons ineligible for Medicare. With the exception of physical therapy visits in 1999, patients with RA in managed care did not report significantly different utilization of any service for RA than those in fee-for-service in either 1994 and 1999, including hospital admissions and joint replacement surgery. Managed care status in 1994, and change in managed care status between 1994 and 1999, were not associated with significantly different outcomes in 1999.
Conclusion: Despite the growth in the proportion of patients with RA in managed care, those in managed care did not differ from those in fee-for-service settings in utilization or outcomes.