Schneider E, Zaslavsky A, Epstein A; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1430.
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: For-profit health plans now enroll the majority of Medicare beneficiaries that select managed care. Prior research has provided conflicting results about whether for-profit health plans provide lower quality of care. The objective was to compare the quality of care delivered by for-profit and not-for-profit health plans using Medicare HEDIS clinical measures. STUDY DESIGN: Observational study comparing HEDIS scores in for-profit and not-for-profit health plans controlling for health plan case-mix, other health plan characteristics, and health plan geographic locations. HEDIS measures included 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 during 1997 who enrolled in Medicare+Choice health plans. PRINCIPAL FINDINGS: The quality of care was lower in for-profit health plans than in not-for-profit health plans on all four of the HEDIS measures we studied (67.5 % vs. 74.8% for BCS, 43.7% vs. 57.7% for DEE, 63.1% vs. 75.2% for BBMI, and 42.1% vs. 60.4% for FHMI). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for three of the four measures (excluding BBMI). Different geographic locations of for-profit and not-for-profit health plans did not explain our results. On average, neither for-profit or not-for-profit health plans achieved optimal performance. CONCLUSIONS: Using standardized performance measures collected by the Medicare program, we found that for-profit health plans provide lower quality of care than not-for-profit health plans. For both types of health plans performance is not yet optimal. Most health plans could improve the quality of care. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Identifying the management strategies and clinical practices that produce better clinical quality in not-for-profit plans may be useful in helping poor performing plans, whether for-profit or not-for-profit to improve the quality of clinical care.
Publication Types:
Keywords:
- Diagnosis-Related Groups
- Health Facilities, Proprietary
- Managed Care Programs
- Medicare
- Medicare Part C
- economics
- hsrmtgs
UI: 103624464
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