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may not have the technical expertise to take on full responsibility for STD prevention. In addition, the types of managed care organizations that currently dominate the market typically do not have highly developed systems for ensuring quality care.
Many managed care organizations may be reluctant to provide STD-related services that have not been shown to be cost-saving for the organization. For example, the long interval between infection and appearance of consequences of STDs may be years; managed care organizations with high turnover rates may have little incentive to emphasize STD-related services. In addition, capitated payments for services may increase the risk of cost-shifting by managed care organizations. For example, health plans may refer persons in need of STD-related services to public STD clinics to avoid assuming the costs of their care.
Persons with STDs may prefer to receive care at public STD clinics and may not feel comfortable receiving care through a managed care organization for a variety of reasons. A recent multisite survey of STD clinic patients showed that most persons surveyed chose a public STD clinic over other providers because of the convenience of obtaining care without an appointment and lower costs (Celum et al., 1995). The lack of walk-in services among many managed care organizations may result in delays for evaluation and treatment of STDs.
Managed care organizations may not provide services to sex partners of plan members if the partner is not a plan member. Many aspects of STD prevention, such as partner notification, screening and case finding, and community education, may involve persons who are not members of the managed care organization.
The billing and claims-processing procedures of some health plans may be a major barrier to confidential STD-related services, particularly for dependent minors. In approximately one-third of managed care organizations surveyed, the employee-beneficiary is likely to be notified of care for their dependents through a copayment bill or other means (Benson Gold and Richards, 1996). Of particular concern are billing procedures among traditional indemnity insurance plans, preferred provider organizations, and point-of-service networks, which often result in lack of confidentiality for dependents because the employee-beneficiary is usually required to be involved in the claims process.
Data regarding the impact of managed care on STD-related services are limited. One study examined the effect of managed care enrollment on the management of three ambulatory conditions (vaginitis, pelvic inflammatory disease, and urinary tract infection) among Medicaid recipients (Carey and Weis, 1990). The authors found that the presence of managed care plans did not reduce diagnostic testing or return visits for the three conditions, compared to fee-for-service providers. Many of the potential concerns mentioned above regarding expanding the role of managed care in STD prevention are similar to those associated with