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The findings indicate that the type of health plan was less important than differences in the type of patient population served, local provider networks, access to care and adherence to treatment recommendations, the study authors stated.

Part of the reason for the differences may be in poor reimbursement from Medicaid, said Greg Scandlen, founder for Consumers for Health Care Choices, a nonprofit advocacy group for health-care consumers.

"We also know after dozens of studies that low-income people do less well in health-care programs regardless of what the program is like," Scandlen continued. "It may be as much to do with treatment as it is lifestyle, education, poor nutrition -- a whole laundry list that plagues the lower classes, and I don't think anybody has found a solution to that."

Landon agreed: "These [Medicare patients] are more challenging patients. You might need different resources arrayed in a different way. Even though the health plans have similar care delivery networks, the providers that are seen by Medicaid enrollees might be different from others because of where they live... They might be accessing parts of the delivery system that are not as effective."

In any event, managed care does not seem to be the solution for reducing disparities in the U.S. health-care system, the study authors said.

More information

Visit the U.S. Centers for Medicare & Medicaid Services for more on Medicaid managed care.

SOURCES: Bruce E. Landon, M.D., associate professor of health care policy and medicine, Harvard Medical School, Boston; A. Mark Fendrick, M.D., professor of internal medicine, University of Michigan School o
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