Managed care and the pediatric emergency department

As an answer to the spiraling costs of health care, enrollment in managed care organizations has expanded over the past 10 years. Today 63% of all employees and their families are covered by some type of managed care plan. The philosophy of managed care organizations, legal responsibilities of the emergency department, the medical needs of the patients, and the financial responsibilities of emergency department, and the managed care organization are all factors influencing the interaction of the children and their families covered by a managed care organization in the emergency department. This article explores the interactions between emergency departments, managed care organizations, and pediatric emergency care. It is aimed at helping the pediatrician and emergency physician understand the position of the emergency department, and the complexities of the managed care organizations when dealing with children seeking emergency care.