This Note explores the impact of current managed care contractual practices on the subspecialty provider's ability to deliver health care to chronically ill and disabled children. In doing so, it delves into the historical events giving rise to the development of health care reform. It then reviews various physician agreements with several managed care organizations ("MCOs") to demonstrate how contract conditions affect compensation for pediatric neurosurgical services. This Note then details the impact of managed care on the management of the chronic health problems of such children and proposes alternative solutions for affordable health care delivery systems for poor, medically fragile groups with complex health problems.



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