• Confidentiality of services. One of the major concerns regarding the ability of MCOs to deliver STD-related services is related to safeguarding the confidentiality of such services. Automated information systems and the team-oriented approach to care associated with most MCOs increase provider, employer, and potential public access to medically sensitive information. Ensuring confidentiality for STD-related services is especially critical for adolescents. It is important to allow adolescents to receive care without parental consent and to ensure that their parents are not notified of STD-related treatment through billing or other means.
  • Uninsured persons. Inadequate access to health care for uninsured persons is a major barrier to STD prevention. Increasing competition resulting from the move towards managed care and reductions in publicly financed health care may reduce access. This may result from public hospitals and clinics shutting down or curtailing services and from decreasing eligibility thresholds for publicly financed programs such as Medicaid. Therefore, even if MCOs assume full responsibility for STD prevention and provide the same spectrum of services as public programs, public STD clinics may still be needed to provide services to persons who neither have private insurance nor qualify for Medicaid or other public assistance.
  • Quality of care. Capitated payments for services encourage MCOs to limit costs. It is possible that MCOs, compared to providers who are reimbursed for their rendered services, may be less willing to conduct diagnostic and screening tests, thereby potentially compromising the quality of care. In addition, the short amount of time available for routine appointments may be a disincentive for MCO providers to become involved in patient education and prevention activities, since these activities require an investment of time.
  • Interest and mission. STDs are not a priority for most MCOs, especially those that do not serve populations at high risk for STDs. It is logical to expect that MCOs serving high-risk populations, such as Medicaid participants, will be more interested in STD prevention than health plans serving lower-risk populations, such as employer-sponsored groups. An MCO's interest in STD prevention may also be dependent on its mission. The mission of the MCO is often closely aligned with the MCO's status as a nonprofit or for-profit organization. For example, nonprofit MCOs are more likely to reinvest their excess revenue in the organization, whereas for-profit MCOs are obligated to funnel a substantial portion of their profits to their stockholders or owners. The mission of for-profit MCOs, therefore, may be in conflict with providing services, such as preventive services, that are not cost-saving to the organization.
  • Variability of MCOs. There is a wide spectrum of MCOs, and consequently there is a wide range of technical ability among MCOs in providing STD-related services. In general, MCOs that have greater service coordination and oversight (e.g., staff- and group-model MCOs) are likely to be more effective in STD prevention than MCOs with less infrastructure (e.g., IPAs). Given the limited

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