Schneider E, Zaslavsky A, Epstein AM; AcademyHealth. Meeting (2003 : Nashville, Tenn.).
Abstr AcademyHealth Meet. 2003; 20: abstract no. 421.
Harvard School of Public Health, Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115 Tel. (617) 432-3124 Fax (617) 432-4494
RESEARCH OBJECTIVE: Prior research suggests that the quality of care in for-profit health plans is lower than that in not-for-profit health plans, however past studies have relied on voluntary health plan reporting of data. Past comparisons of quality of care could be biased if for-profit and not-for-profit health plans differed in their willingness to report. STUDY DESIGN: The Center for Medicare and Medicaid Services (CMS) mandates reporting of standardized data using HEDIS(TM) specifications. Merging these data with InterStudy data on health plan characteristics, we compared the quality of care of for-profit and not-for-profit health plans. We studied four clinical services: breast cancer screening (BCS), diabetic eye examinations (DEE), beta-blocker medication after myocardial infarction (BBMI), and follow-up after hospitalization for mental illness (FHMI). POPULATION STUDIED: Medicare beneficiaries age 65 and older and enrolled in Medicare+Choice health plans during 1997. PRINCIPAL FINDINGS: Among the 234 study health plans, 65% were for-profit. On all four of the HEDIS(TM) measures we studied, the quality of care was lower among for-profit health plans than among not-for-profit health plans (67.4 % vs. 74.4% for BCS, 44.0% vs. 57.8% for DEE, 63.7% vs. 75.5% for BBMI, and 41.9% vs. 61.6% for FHMI). After adjustment for sociodemographic case-mix and health plan characteristics (total enrollment, Medicaid enrollment, model type, age of health plan, and region) the quality of care remained lower in for-profit health plans than not-for-profit health plans, but these differences were not statistically significant for the BCS and BBMI measures. CONCLUSIONS: Medicare beneficiaries enrolled in for-profit health plans receive lower quality of care than those enrolled in not-for-profit health plans. However part of the difference in quality of care may be explained by other features of for-profit health plans or the areas in which they operate. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: CMS should continue to monitor the quality of care delivered by for-profit health plans and may want to intiate programs to improve care delivery within these plans.
Publication Types:
Keywords:
- Diagnosis-Related Groups
- Health Facilities, Proprietary
- Medicaid
- Medicare
- Medicare Part C
- economics
- hsrmtgs
Other ID:
UI: 102275398
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