Medicare managed care appears to be providing better access to primary care and more affordable care, say these researchers from the National Rehabilitation Hospital Center and Disability Research. Yet this is not necessarily true for those with poor health or who have severe disabilities.
Health care access, affordability, and satisfaction with quality of care was the focus of this random sample of 6,116 beneficiaries ages 18 to 64. Each qualified for Medicare as working-age disabled or as an elderly individual with one instrumental daily living activity limitation. Access to health care was divided into "access," the usual source of care. "Realized" access was the person's experience with the health care system, and "equitability" of access was the distribution of service based on need.
After a series of analytic tasks, results indicated that Medicare beneficiaries with functional limitations enrolled in HMOs were in better health than counterparts in traditional Medicare. About two-thirds (66.4%) said they were in good, very good, or excellent health compared with 52.64% of those with traditional coverage. Those with traditional beneficiaries and those in HMOs said they had difficulty with a daily living activity.
As for access, those with Medicare who had disabilities and enrolled in HMOs were 2.61 times more likely to have a usual source of care and half as likely to have had a health problem for which they did not see a doctor, compared with counterparts in traditional coverage. Those under age 65 who qualified for Medicare with disabilities were 60% more likely as elderly beneficiaries with disabilities to have a usual source of care. For each year increase in age, beneficiaries were less likely to have had a health problem without seeing a doctor.
People in HMO were 35% more likely to delay seeking medical care because of cost than those in traditional Medicare. Results showed that Medicare HMO enrollees with disabilities were more satisfied with health care costs and less likely to delay getting health care because of cost. Both groups had about the same satisfaction level, which was high (90%).
"These results, taken as a whole, indicate that access, affordability, and satisfaction with quality vary greatly for individuals with disabilities, based on health status and disability severity. They also indicate that health status and disability severity should not be substituted for another in health services and rehabilitation research. Both disability severity and health status were independently related to the variables of access, affordability, and satisfaction with quality after controlling for all other independent variables. An individual may have a disability yet consider him or herself to be in good health, just as an individual may report poor health but experience no disability."
These findings indicated that managed care is achieving some of its goals with people with disabilities, especially greater access and affordability. Yet results also showed that people who have more severe disabilities or poorer health status were most likely to have negative health care experiences. An important point to note about this research is that this study did not examine access to specialty care, rehabilitation services, home health care, acute care, durable medical equipment, and assistive technology. These "downstream'" or specialty services are the ones the managed care typically restricts, which could be problematic to people with disabilities in managed care.
This research was supported by the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education. #827
Beatty, P. W., & Dhont, K. R. (2001). Medicare health maintenance organizations and traditional coverage: Perceptions of health care among beneficiaries with disabilities. Archives of Physical Medicine Rehabilitation 82, 1009-1017.