Access to Care in Medicare HMOs, 1996

Health Affairs

Volumn 16, Issue 2, 1997, Pages 148-156

  Nelson, Lyle ^a   Brown, Randall ^a   Gold, Marsha ^a   Ciemnecki, Anne ^a   Docteur, Elizabeth ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; EPIDEMIOLOGY; HEALTH CARE DELIVERY; HEALTH MAINTENANCE ORGANIZATION; HUMAN; MEDICARE; PATIENT SATISFACTION; QUESTIONNAIRE; STANDARD; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

AGED; HEALTH CARE SURVEYS; HEALTH MAINTENANCE ORGANIZATIONS; HEALTH SERVICES ACCESSIBILITY; HUMANS; MEDICARE; PATIENT SATISFACTION; QUESTIONNAIRES; UNITED STATES;

EID: 0001170532     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.2.148     Document Type: Article

References (16)

1. Health Care Financing Administration, Medicare Prepaid Health Plans Monthly Report (Baltimore: HCFA, December 1994 and January 1997).
2. M. Moon and K. Davis, "Preserving and Strengthening Medicare," Health Affairs (Winter 1995): 31-46.
3. R.S. Brown et al., "Do Health Maintenance Organizations Work for Medicare?" Health Care Financing Review 15, no. 1 (1993): 7-24.
4. J. Ware et al., "Differences in Four-Year Health Outcomes for Elderly and Poor, Chronically Ill Patients Treated in HMO and Fee-for-Service Systems: Results from the Medical Outcomes Study," Journal of the American Medical Association 276, no. 13 (1996): 1039-1047.
5. L. Nelson et al., "Access to Care in Medicare Managed Care: Results from a 1996 Survey of Enrollees and Disenrollees," Selected External Research Series no. 7 (Washington: Physician Payment Review Commission, November 1996).
6. If we had included beneficiaries enrolled for only one month in our sample, the rate of disenrollment to fee-for-service would increase from 2.8 percent to 3.3 percent. We excluded beneficiaries who were in a plan for only one month (14 percent of disenrollees during the year), since many of these persons may not have realized that they had enrolled or may have changed their mind about enrolling before having any real experience obtaining care within the plan (frequently because they had not realized that they were required to obtain care only from HMO-affiliated physicians).
7. E.R. Docteur, D.C. Colby, and M. Gold, "Shifting the Paradigm: Monitoring Access in Medicare Managed Care," Health Care Financing Review 17, no. 4 (1996): 5-21.
8. Our disenrollment figures are lower than those recently reported in U.S. General Accounting Office, Medicare: HCFA Should Release Data to Aid Consumers, Prompt Better HMO Performance, GAO/HEHS-97-23 (Washington: GAO, October 1996). The GAO presented only plan-specific estimates of disenrollment (which vary greatly) and included only plans in California and Florida. The GAO estimates did not distinguish between switching between risk plans and disenrolling to fee-for-service, and they included beneficiaries whose disenrollment date was identical to their enrollment date (those who canceled their HMO membership before their effective enrollment date) and those who were enrolled for only one month. Such persons were excluded from our study for the reasons described above.
9. R.S. Brown et al., "The Medicare Risk Program for HMOs - Final Summary Report on Findings from the Evaluation," HCFA Contract no. 500-88-0066 (Baltimore: HCFA, February 1993).
10. These estimates were adjusted to account for differences between HMO enrollees and fee-for-service beneficiaries in age, race, and health status. However, the difference in mammography rates may be attributable in part to differences between the two groups in the age distribution of women in the sixty-five to eighty-four age range, since some guidelines do not recommend annual mammograms for women over age seventy-five.
11. Physician Payment Review Commission, Monitoring Access of Medicare Beneficiaries, No. 95-1 (Washington: PPRC, May 1996).
12. Nelson et al., "Access to Care in Medicare Managed Care."
13. PPRC, Monitoring Access of Medicare Beneficiaries.
14. Docteur et al., "Shifting the Paradigm."
15. Ibid.
16. P.W. Shaughnessey, R.E. Schlenker, and D.F. Hittle, "Home Health Care Outcomes under Capitated and Fee-for-Service Payment," Health Care Financing Review 16, no. 1 (1994): 187-222.