Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries - 21/08/11
, Alan M. Zaslavsky, PhD b, Arnold M. Epstein, MD, MA a
Requests for reprints should be addressed to Eric C. Schneider, MD, MSc, Brigham and Women’s Hospital, General Medicine Bima, 75 Francis Street, Boston, MA 02115Abstract |
Background |
For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care.
Objective |
The objective was to compare the quality of care delivered by for-profit and not-for-profit health plans using Medicare Health Plan Employer Data and Information Set (HEDIS) clinical measures.
Research design |
This was an observational study comparing HEDIS scores in for-profit and not-for-profit health plans that enrolled Medicare beneficiaries in the United States during 1997.
Outcome measures |
Outcome measures included health plan quality scores on each of 4 clinical services assessed by HEDIS: breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness.
Results |
The quality of care was lower in for-profit health plans than not-for-profit health plans on all 4 of the HEDIS measures we studied (67.5% vs 74.8% for breast cancer screening, 43.7% vs 57.7% for diabetic eye examination, 63.1% vs 75.2% for beta-blocker medication after myocardial infarction, and 42.1% vs 60.4% for follow-up after hospitalization for mental illness). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for 3 of the 4 measures (not beta-blocker medication after myocardial infarction). Different geographic locations of for-profit and not-for-profit health plans did not explain these differences.
Conclusion |
By using standardized performance measures applied in a mandatory measurement program, we found that for-profit health plans provide lower quality of care than not-for-profit health plans. Special efforts to monitor and improve the quality of for-profit health plans may be warranted.
Le texte complet de cet article est disponible en PDF.Keywords : Medicare, Quality of care, Managed care, Financing
Plan
| This research was supported by a grant from the Commonwealth Fund. Dr. Zaslavsky was supported by a grant from the Agency for Health Care Research and Quality (PO1-HS10803). |
Vol 118 - N° 12
P. 1392-1400 - décembre 2005 Retour au numéro
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