Access Type

Open Access Dissertation

Date of Award


Degree Type


Degree Name




First Advisor

Allen C. Goodman


This dissertation attempts to examine the quality effect of managed care plans (as compared with traditional fee-for-service plans, or FFS) on the health outcome and health care use of patients with diabetes. As the number of diabetics is growing rapidly with many of them are relying on managed care plans, knowing better the effects of different plans on health status and health care utilization is of great interest and significance to consumers, employers, and policymakers, especially at a time that universal health care is under being implemented.

Using up-to-date data from MEPS, a nationally representative survey, I compared 484 HMO patients, 356 OMC patients, with 161 patients (who presented with diabetes) in terms of access to, satisfaction with, utilization of care (including diabetes care), and health status, to evaluate the quality of health care enrollees receive and their health outcome.

The main empirical findings in this study provide favorable evidence for the performance of managed care. Most of the measures we used to evaluate the quality of health care of managed care plans exhibited comparable level or even better to traditional FFS plans. Specifically, in terms of access to care,: 1) HMO enrollees were more likely having USC provider than FFS enrollees; 2) The providers in HMOs were more likely to have nights/weekends office hours when compared to FFS enrollees; 3) And, HMO enrollees were much easier to see providers. With regard to satisfaction with the providers, the analysis found no significant differences in any measures across the three types of plans. As for use of health care, HMO enrollees have lower number of nights in hospital for discharges and were more often treated with diet modification compared to FFS enrollees. In regards to health outcome, HMO enrollees were more likely fallen in category of "excellent" health when compared to FFS enrollees. OMC plans exhibited no difference from FFS plans.