Who is enrolled in for-profit vs. nonprofit medicare HMOs?

Health Affairs

Volumn 19, Issue 1, 2000, Pages 210-220

  Blustein, Jan ^a   Hoy, Emma C ^b  

^a NEW YORK UNIVERSITY   (United States)

^b Wagner School   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGE; AGED; ARTICLE; COMPARATIVE STUDY; CROSS-SECTIONAL STUDY; DAILY LIFE ACTIVITY; EDUCATIONAL STATUS; EPIDEMIOLOGY; FEMALE; GERIATRIC ASSESSMENT; HEALTH MAINTENANCE ORGANIZATION; HEALTH STATUS; HUMAN; INVESTMENT; MALE; MEDICARE; MIDDLE AGED; NON PROFIT ORGANIZATION; ORGANIZATION AND MANAGEMENT; PATIENT SATISFACTION; POVERTY; UNITED STATES; UTILIZATION REVIEW;

ACTIVITIES OF DAILY LIVING; AGE FACTORS; AGED; AGED, 80 AND OVER; CROSS-SECTIONAL STUDIES; EDUCATIONAL STATUS; FEMALE; GERIATRIC ASSESSMENT; HEALTH CARE SURVEYS; HEALTH MAINTENANCE ORGANIZATIONS; HEALTH STATUS; HUMANS; INVESTMENTS; MALE; MEDICARE; MIDDLE AGED; ORGANIZATIONS, NONPROFIT; OWNERSHIP; PATIENT SATISFACTION; POVERTY; UNITED STATES;

EID: 0003537168     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.19.1.210     Document Type: Article

References (32)

1. R.S. Brown et al., The Medicare Risk Program for HMOs - Final Summary Report on Findings from the Evaluation, Final report under HCFA Contract no. 500-88-0006 (Princeton, N.J.: Mathematica Policy Research, 1993); G. Riley et al., "Health Status of Medicare Enrollees in HMO and Fee-for-Service in 1994," Health Care Financing Review 17, no. 4 (1996): 65-76; and Physician Payment Review Commission, Annual Report to Congress, 1996 (Washington: PPRC, 1996).
2. R.S. Brown et al., The Medicare Risk Program for HMOs - Final Summary Report on Findings from the Evaluation, Final report under HCFA Contract no. 500-88-0006 (Princeton, N.J.: Mathematica Policy Research, 1993); G. Riley et al., "Health Status of Medicare Enrollees in HMO and Fee-for-Service in 1994," Health Care Financing Review 17, no. 4 (1996): 65-76; and Physician Payment Review Commission, Annual Report to Congress, 1996 (Washington: PPRC, 1996).
3. R.S. Brown et al., The Medicare Risk Program for HMOs - Final Summary Report on Findings from the Evaluation, Final report under HCFA Contract no. 500-88-0006 (Princeton, N.J.: Mathematica Policy Research, 1993); G. Riley et al., "Health Status of Medicare Enrollees in HMO and Fee-for-Service in 1994," Health Care Financing Review 17, no. 4 (1996): 65-76; and Physician Payment Review Commission, Annual Report to Congress, 1996 (Washington: PPRC, 1996).
4. J.P. Newhouse, M.B. Buntin, and J.D. Chapman, "Risk Adjustment and Medicare: Taking a Closer Look," Health Affairs (Sep/Oct 1997): 26-43.
5. See, for example, R. Kuttner, "Must Good HMOs Go Bad? The Commercialization of Prepaid Group Health Care," New England Journal of Medicine 338, no. 21 (1998): 1558-1563 ("As a group, they [for-profit HMOs] tend to engage in more aggressive risk selection," page 1561). Also see K.M. Lawrence, P.H. Mattingly, and J.M. Ludden, "Trusting in the Future: The Distinct Advantage of Non-profit HMOs," Milbank Quarterly 75, no. 1 (1997): 5-10 ("Resisting pressure from private purchasers to set prices that reflect their risk pools, nonprofit managed care companies have generally favored rating and underwriting practices that protect the community and spread the risks. Most nonprofit HMOs maintain the premise that the interests of the community are best served when the costs of illness are shared through community rating rather than adjusted for the benefit of employers with the youngest work forces.").
6. See, for example, R. Kuttner, "Must Good HMOs Go Bad? The Commercialization of Prepaid Group Health Care," New England Journal of Medicine 338, no. 21 (1998): 1558-1563 ("As a group, they [for-profit HMOs] tend to engage in more aggressive risk selection," page 1561). Also see K.M. Lawrence, P.H. Mattingly, and J.M. Ludden, "Trusting in the Future: The Distinct Advantage of Non-profit HMOs," Milbank Quarterly 75, no. 1 (1997): 5-10 ("Resisting pressure from private purchasers to set prices that reflect their risk pools, nonprofit managed care companies have generally favored rating and underwriting practices that protect the community and spread the risks. Most nonprofit HMOs maintain the premise that the interests of the community are best served when the costs of illness are shared through community rating rather than adjusted for the benefit of employers with the youngest work forces.").
7. J. Gabel, "Ten Ways HMOs Have Changed during the 1990s," Health Affairs (May/June 1997): 134-145.
8. Health Care Financing Administration, Medicare Managed Care Contract Report (Baltimore: HCFA, December 1990 and December 1996).
9. Ibid.
10. G. Adler, "A Profile of the Medicare Current Beneficiary Survey," Health Care Financing Review 15, no. 4 (1994): 153-163. For details on the 1996 sample, see HCFA Office of Strategic Planning, Information and Methods Group, 1996 Medicare Current Beneficiary Survey, Access to Care Public Use File, Section 6: Sample Design and Estimation (November 1997).
11. G. Adler, "A Profile of the Medicare Current Beneficiary Survey," Health Care Financing Review 15, no. 4 (1994): 153-163. For details on the 1996 sample, see HCFA Office of Strategic Planning, Information and Methods Group, 1996 Medicare Current Beneficiary Survey, Access to Care Public Use File, Section 6: Sample Design and Estimation (November 1997).
12. Ibid.
13. The weights supplied by HCFA also account for subjects' nonresponse to the survey. Additionally, SUDAAN software was used to compensate for the potential bias in standard errors that might result from cluster sampling in the MCBS sample. See B.V. Shah, B.G. Barnwell, and G.S. Bieler, SUDAAN: Software for the Statistical Analysis of Correlated Data, Users Manual, Release 7.5 (Research Triangle Park, N.C.: RTI, 1997).
14. HCFA, Office of Managed Care, Monthly Report: Medicare Managed Care Plans (Baltimore: HCFA, December 1996).
15. Plans report their ownership status when they apply to participate in Medicare. Updates are performed periodically. P. Doerr, HCFA Office of Managed Care, personal communication, 2 February 1999. To validate our findings, we also conducted confirmatory analyses using InterStudy reports as our source of information on plan ownership. InterStudy, The Competitive Edge 72, Part 1: HMO Directory (Minneapolis: InterStudy, September 1997). Our findings on the impact of ownership status were essentially unchanged.
16. Plans report their ownership status when they apply to participate in Medicare. Updates are performed periodically. P. Doerr, HCFA Office of Managed Care, personal communication, 2 February 1999. To validate our findings, we also conducted confirmatory analyses using InterStudy reports as our source of information on plan ownership. InterStudy, The Competitive Edge 72, Part 1: HMO Directory (Minneapolis: InterStudy, September 1997). Our findings on the impact of ownership status were essentially unchanged.
17. Specifically, in a simultaneous logistic regression model, low income, less education, and shorter duration of enrollment were all positively and significantly associated with enrollment in a for-profit health plan.
18. Barents Group LLC, "Changes in Medicare HMO Payment Policy: Effects on HMO Participation, Benefits, and Medicare Enrollment," Report prepared for the Henry J. Kaiser Family Foundation (Washington: Kaiser Family Foundation, May 1997).
19. U.S. General Accounting Office, Medicare: Many HMOs Experience High Rates of Disenrollment, GAO/HEHS-98-142 (Washington: GAO, April 1998); and R.O. Morgan et al., "The HMO-Medicare Revolving Door - The Healthy Go In and the Sick Go Out," New England Journal of Medicine 337, no. 3 (1997): 169-175.
20. U.S. General Accounting Office, Medicare: Many HMOs Experience High Rates of Disenrollment, GAO/HEHS-98-142 (Washington: GAO, April 1998); and R.O. Morgan et al., "The HMO-Medicare Revolving Door - The Healthy Go In and the Sick Go Out," New England Journal of Medicine 337, no. 3 (1997): 169-175.
21. See Families USA Foundation, Comparing Medicare HMOs: Do They Keep Their Members? (Washington: Families USA, December 1997); Prospective Payment Assessment Commission/Physician Payment Review Commission, Joint Report to Congress on Medicare Managed Care (Washington: ProPAC/PPRC, October 1995).
22. See Families USA Foundation, Comparing Medicare HMOs: Do They Keep Their Members? (Washington: Families USA, December 1997); Prospective Payment Assessment Commission/Physician Payment Review Commission, Joint Report to Congress on Medicare Managed Care (Washington: ProPAC/PPRC, October 1995).
23. Moran, "The HMO-Medicare Revolving Door"; and G.F. Riley, E.J. Feuer, and J.D. Lubitz, "Disenrollment of Medicare Cancer Patients from Health Maintenance Organizations," Medical Care 34, no. 8 (1996): 826-836.
24. Moran, "The HMO-Medicare Revolving Door"; and G.F. Riley, E.J. Feuer, and J.D. Lubitz, "Disenrollment of Medicare Cancer Patients from Health Maintenance Organizations," Medical Care 34, no. 8 (1996): 826-836.
25. See B.H. Gray, "Conversion of HMOs and Hospitals: What's At Stake?" Health Affairs (Mar/April 1997): 29-47.
26. P. Neuman et al., "Marketing HMOs to Medicare Beneficiaries," Health Affairs (July/Aug 1998): 132-139.
27. A.M. Epstein, R.S. Stern, and J.S. Weissman, "Do the Poor Cost More? A Multihospital Study of Patients' Socioeconomic Status and Use of Hospital Resources," New England Journal of Medicine 332, no. 16 (1990): 1122-1128.
28. J. Blustein, K. Hanson, and S. Shea, "Preventable Hospitalizations and Socioeconomic Status," Health Affairs (Mar/Apr 1998): 177-189.
29. From 1997 MCBS data, reported in D.L. Gross et al., "Out-of-Pocket Health Spending by Poor and Near-Poor Elderly Medicare Beneficiaries," Health Services Research (April 1999): 241-254.
30. B. Jarman, "Public Policy Issues: A British Perspective," Journal of the Royal Society of Medicine 88, Supp. 26 (1995): 11-12.
31. Families USA Foundation, Special Report: The Crushing Costs of Medicare Supplemental Policies (Washington: Families USA, October 1996).
32. National Health Policy Forum, Medicare HMO Pullouts: What Do They Portend for the Future of Medicare+Choice? Issue Brief no. 730 (Washington: NHPF, February 1999).