Private Payers Serving Individuals with Disabilities and Chronic Conditions. A. Introduction


Chapter 1 noted that nearly half of those with disabilities are enrolled in private sector health care plans, yet little research has been conducted on their experiences in those plans. Managed care has been touted as having great potential for those who have disabling chronic illness, since one case manager or gatekeeper can take responsibility for guiding patients through the maze of services and providers that may be necessary to treat chronic conditions. Managed care has also been equated with managed cost, however, implying that more consideration is given to reducing the cost of providing care than to the needs of the patient. Both goals--reducing inefficiencies to control costs and managing care to promote quality--are laudable and not necessarily conflicting. To judge whether managed care is beneficial for people with chronic illness, it is important to have a clear understanding of their experiences in private sector health plans.

There are relatively few studies of the experience of people with disabilities in private sector indemnity and managed care plans, and thus we start by addressing basic issues. The insights gained will lead to more focused questions to be examined in subsequent research. The next four chapters of this report describe studies we conducted with data provided by two large employers. A brief overview of these studies is offered below.

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