This briefing report is written to alert public and private sector decision makers to the potential advantages and disadvantages of a health care reform strategy based on managed competition from the perspective of an important and vulnerable population — children with special health care needs. Nearly a third of all children in the U.S. currently have a chronic physical, developmental, learning, emotional, and behavioral problem. A small but growing proporation of children — 6 percent nationwide — are limited in their ability to play or to attend school. Many of these children are poor; in fact, poor children are more likely to experience severe health problems than their nonpoor counterparts.
The United States stands poised to legislate and implement health care reform on a national level, even as reforms are being implemented in states and localities. A substantial amount of activity has coalesced around reform based on two related approaches: managed competition and managed care. Managed care is an approach to delivering health care that is featured prominently in a managed competion model, but it is rapidly developing on its own and will play a large part in the future regardless of the specific reforms enacted.