The Effect of Managed and Traditional Care Insurance Plans on Horizontal Inequity in Access to Health Care in the United States

This study examines income inequity in access to health care in the United States. Given the predominant and growing presence of managed care organizations as a source of medical insurance and care in both the private and public settings, replacing traditional indemnity plans as a lower cost prophylactic alternative, we speculate that the presence of Managed Care Organizations would reduce, if not eliminate, any pro wealthy bias in access to health care for the insured population in the U.S. We rely on previously developed methodology from the EcuityII project, incorporating the health inequity index (HIWV), to estimate income inequity in traditional indemnity and managed care plans. Our results are surprisingly counterintuitive to the expected result that managed care was designed to have on access to care. The calculated HIWV indicates a relatively greater pro wealthy bias in the managed care group. This result has important and direct policy implications as public insurance programs in the U.S. contract with managed care organizations as a lower cost alternative for Medicaid and Medicare beneficiaries.