Health Care Plans for Medicare Beneficiaries Are Not All Alike

Newswise — If you are a Medicare beneficiary, should it matter whether your health care plan is for-profit or not-for-profit? According to a study published in the December issue of The American Journal of Medicine, it may.

By analyzing the first mandatory reporting of Quality-of-Care (QOC) data for Medicare patients, researchers from the Department of Health Policy and Management, Harvard School of Public Health; and the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, found that for-profit plans provided significantly lower quality of care than not-for-profit plans.

Until 1997, QOC data came from surveys, was voluntarily provided by health plans, or came from regional plans. As such, some of these data may have been affected by biased selection and none of the data accounted for known geographic variation in the delivery of care. After 1997, reporting QOC data became mandatory in the Medicare program, thus providing nationwide data in the form of the Health Plan Employer Data and Information Set (HEDISâ„¢). Using four measures of care, breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness, the authors report that for-profit plans had lower ratings in all four measures than not-for-profit plans. Even after correcting for sociodemographic factors and health plan differences, for-profit plans still trailed not-for-profits in 3 of the 4 measures.

Writing in the article, Eric C. Schneider, MD, MSc, Alan M. Zaslavsky, PhD, and Arnold M. Epstein, MD state, "These results are particularly important for two reasons. First, since the late 1990s, the majority of health plans that have enrolled Medicare beneficiaries have been for profit. Second, the measures we studied are based on widely accepted standards of care for the clinical services they assess. There is a high degree of consensus that these clinical services can reduce morbidity and mortality if beneficiaries receive them." They continue, "In conclusion, we found that the quality of care delivered to Medicare beneficiaries is substantially lower in for-profit health plans compared with not-for-profit health plans"¦.Our findings are not only consistent with prior research but also reinforce the concern that the financial incentives of for-profit plans lead to less aggressive efforts to manage the quality of care." The investigators recommend that quality monitoring should be cornerstone of federal government efforts to optimize the quality of health care for Medicare beneficiaries.

The study, "Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries" by Eric C. Schneider, MD, MSc, Alan M. Zaslavsky, PhD, and Arnold M. Epstein, MD, MA, appears in The American Journal of Medicine, Volume 118, Number 12 (December 2005), published by Elsevier. This research was supported by a grant from the Commonwealth Fund.

© 2005 The American Journal of Medicine. All rights reserved. Unauthorized use prohibited.

The American Journal of Medicine, known as the "Green Journal," is one of the oldest and most prestigious general internal medicine journals published in the United States. AJM, the official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus U.S. medical schools, publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. AJM is published by Elsevier, a leading global publisher of scientific, technical, and medical journals, books, and reference works. It is a member of the Reed Elsevier plc group.