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To the Editor: I have 2 concerns about the article by Dr Thompson and colleagues.¹ First, the rates of compliance with the quality measurements were very low in children with both Medicaid managed care and commercial managed care. For instance, the authors found a vaccination rate of 69% for the patients in commercial plans, well below the stated national target of 90%, which has not been changed since originally set by the US Public Health Service.² If the authors had examined a commercially insured population with higher overall rates of childhood vaccination, the results for children covered by Medicaid managed care might have been more similar. I am also concerned about their use of myringotomy tube placement as a reflection of the care of the managed care plan or of the primary care physician. These measures are also influenced by whether the specialist treats the Medicaid and non-Medicaid patients similarly.

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Stephen R. Coleman, MD
Coleman Pediatric Associates, PA
Raleigh, NC

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