Parents' Perspectives of Managed Care: Implications for Pediatric Physical Therapy.

Parents' Perspectives of Managed Care: Implications for Pediatric Physical Therapy O'Neil M, Farel A, Palisano RJ (Department of Physical Therapy, Medical College of Pennsylvania/Hahnemann University, Philadelphia, Pa; Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC), Pediatr Phys Ther. 1999;11:24-32.

This study surveyed parents of children with chronic conditions regarding their children's health care plans. Its purpose was to investigate the impact of managed care and fee-for-service plans on access to health care services and to compare parent satisfaction with the 2 models of service delivery. Parental satisfaction with health care services is an outcome measure for monitoring practice patterns in physical therapy; therefore, services pertinent to pediatric physical therapy were identified for specific comparison. The survey questions examined parents' perceptions of (1) their child's health coverage in their plans; (2) the impact of managed care and fee-for-service plans on the quality of their child's health services; and (3) their satisfaction with the health services for their children with special health care needs.

This study was the initial phase of a larger project to develop a national database documenting families' perceptions of managed care. Questionnaire items for this study were selected from a questionnaire originally developed by Family Voices, a national grassroots network of families and friends working on behalf of children with special health care needs. Items included in the original questionnaire were taken from parent inquiries to Family Voices to discuss their concerns about the impact of emerging health care models on their children's care. The questionnaire was reviewed and revised by consultants from Family Voices; however, they did not establish validity or reliability.

The questions solicited the following information: (1) demographics; (2) parental satisfaction with the spectrum of health care services, including health coverage, access, coordination, and time; and (3) service implementation. Twelve of tire 20 items in section 2 of the questionnaire that related to pediatric physical therapy were chosen for this study. Open-ended questions were included to provide parents an opportunity to comment regarding their experiences with various aspects of their plan. This "pilot questionnaire" was distributed to and collected from Family Voices state coordinators during a 1995 conference. This distribution method was selected to obtain feedback from individuals with a high level of experience with families. Information gleaned from the pilot questionnaires will he used in the development phase lot the larger project.

A total of 33 surveys, representing 23 states, were coded and analyzed. Frequencies and percentages were calculated for all variables, and Mann-Whitney U tests were used for comparative analysis of the 2 health models for the 12 physical therapy-related items. The mean age of the children from these families was 12 years.

Spina bifida (n=6) and cerebral palsy (n=6) were the most frequently reported diagnoses. Nineteen parents (57.6%) reported that their children were in managed care plans and 14 (42.4%) reported fee-for-service plans. However, many families reported dual coverage. Twenty-six parents (78.7%) indicated that their children had received services from public health or education programs, with 65% reporting receipt of services sponsored by Part B of the Individuals With Disabilities Education Act (IDEA). Results indicated that 90% of the parents were able to choose their children's primary care provider. Of the remaining 10% who reported no choice, all were enrolled in a managed care organization. While the majority reported their primary care provider as knowledgeable, 9% reported their primary care provider as unknowledgable and 2 of these repondents' children were enrolled in a managed care plan.

When parents rated their levels of satisfaction with a wide spectrum of services, between 64.2% and 88.8% reported "good" to "excellent" satis-faction for 8 of the 12 physical therapy-related items. Only 58.6% of the parents indicated "good" to "excellent" satisfaction with specialty service coverage, and only 51.6% gave this same rating to the availability of health care plan information. Less than half of the parents reported satisfaction with the level of coordination among doctors and other health care professionals (46.7%) and access to a care coordinator (29.6%).

Regarding receipt of specialty services, 30 parents (53.3%) reported using "exception to policy" requests to acquire services or equipment related to their children's needs, including home nursing, equipment, Medicaid waivers, and supplies. Sixteen parents reported approval. The type of denied requests varied, but they included denial of additional therapy or mental and nutritional health services. Physical therapy was reported by 4 parents (25%) as a service their children needed but did not receive.

The results of the Mann-Whitney U test indicated that parents of children in fee-for-service plans were significantly more satisfied than parents in managed care plans with the coverage for specialty services, access to pediatric specialists, access to other pediatric health professionals, ability to obtain a second opinion, and how well the plan met their child's needs.

According to the authors, the results of this survey suggest that neither type of health care plan completely met the perceived needs of children with special health care needs and their families. However, it results reflect health care trends, the researchers believed that families and managed care organizations must make adjustments when services for children with special health care needs are required.

Angela Easley Rosenberg, DrPH, PT The University of North Carolina Chapel Hill, NC