Disenrollment of Medicare Cancer Patients from HMOs

Office of Research and Demonstrations, Health Care Financing Administration, Baltimore, MD 21244-1850, USA.
Medical Care (Impact Factor: 3.23). 09/1996; 34(8):826-36. DOI: 10.1097/00005650-199608000-00009
Source: PubMed


There is concern that financial incentives in health maintenance organizations (HMOs) might result in pressures to induce sicker members to disenroll. The authors compared disenrollment rates of Medicare HMO enrollees with cancer with disenrollment rates for cancer-free enrollees, using Medicare enrollment files linked to population-based tumor registry data from the Surveillance, Epidemiology, and End Results (SEER) Program.
The authors identified all aged Medicare beneficiaries who enrolled in an HMO located in a SEER reporting area during 1985 to 1989. Time to disenrollment was analyzed using a proportional hazards model.
Overall, cancer patients were no more likely to disenroll than others. However, persons diagnosed with cancer after enrollment were less likely to disenroll than other persons in Independent Practice Association (IPA) mode HMOs (relative risk [RR] = 0.79). Persons diagnosed with cancer after enrollment in group- and staff-model HMOs were about equally likely to disenroll as other persons (RR = 0.91). Persons diagnosed with cancer less than 18 months before enrollment were at high risk for disenrollment from both IPA and group-/staff-model HMOs (RR = 1.47 and 1.35). There was substantial variation among HMOs in overall disenrollment rates and in RRs for disenrollment by cancer patients.
The low disenrollment rates of patients diagnosed after enrollment do not support the contention that features intrinsic to managed care make HMOs unattractive to the seriously ill. Monitoring of selective disenrollment could be used as a screen for possible access and quality problems.

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    • "The majority of persons whose original reason for enrollment was disability are under age 65. 1 In 2002, the Medicare disabled population included about 6 million individuals (14 percent of all Medicare beneficiaries) and this population is expected to grow by about 3 million over the next 30 years as the entire Medicare population doubles (Centers for Medicare & Medicaid Services, 2002). Because of the incentives for managed care plans to avoid beneficiaries with higher expected costs, policymakers have been concerned that Medicare managed care plans may passively discriminate against disabled beneficiaries in their marketing or benefits structures, effectively encouraging only healthier and more ablebodied members to enroll (Brown et al., 1993; Riley et al., 1996; Mello et al., 2003). For example, in 2000, about 7 percent of enrollees in Medicare managed care plans were in poor health, as compared with 13 percent of enrollees in "
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    ABSTRACT: Disenrollment rates from Medicare managed care plans have been reported to the public as an indicator of health plan quality. Previous studies have shown that voluntary disenrollment rates differ among vulnerable subgroups, and that these rates can reflect patient care experiences. We hypothesized that disabled beneficiaries may be affected differently than other beneficiaries by competitive market factors, due to higher expected expenditures and impaired mobility. Findings suggest that disabled beneficiaries are more likely to experience multiple problems with managed care.
    Health care financing review 02/2005; 26(3):45-62. · 2.06 Impact Factor
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    • "At a minimum, capitated payments contain a disincentive to provide a level or quality of health care that is attractive to persons with costly illness. Despite the policy relevance of the disenrollment behavior of Medicaid managed care clients, all prior studies of health plan disenrollment have focused either on individuals in employer-sponsored private plans (Hennelly and Boxerman 1983; Griffith 1984; Long et al.1988; Robinson et al. 1993; Buchmueller and Feldstein 1997; Shore 1998; Goldman et al. 2003) or Medicare beneficiaries (Riley et al. 1996, 1997; Buchmueller 2000). In this study, we examine the determinants of plan disenrollment within a Medicaid managed care program where members have a choice among many different health plans and can change plans monthly. "
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    ABSTRACT: Consumer decisions to switch health plans have implications for quality of care and risk selection. We examine factors related to time to disenrollment in a Medicaid managed care program where beneficiaries face a menu of plans and can change plans every month. Several findings have direct policy relevance. Families and individuals who make active choices upon entering the program are at substantially lower risk of disenrollment than those who are auto-assigned. Interactions between enrollee ethnicity and provider language proficiency suggest that enrollee satisfaction depends on the cultural competence of providers. Differential disenrollment by risk status results in adverse retention for certain types of plans.
    Inquiry: a journal of medical care organization, provision and financing 12/2004; 41(4):447-60. DOI:10.5034/inquiryjrnl_41.4.447 · 0.55 Impact Factor
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    • "The previous literature provides limited insight into the direct effect of health status on the decision to switch plans. While some early studies find a negative relationship between poor health (or prior utilization) and disenrollment (Wersenger and Sorenson 1982; Hennelly and Boxerman 1983; Griffith 1984), several others, including the two studies most closely related to this one (Long, Settle, and Wrightson 1988; Riley, Feuer, and Lubitz 1996), find little relationship.'3 "
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    ABSTRACT: To investigate the effect of price on the health insurance decisions of Medicare-eligible retirees in a managed competition setting. The study is based on four years of administrative data from the University of California (UC) Retiree Health Benefits Program, which closely resembles the managed competition model upon which several leading Medicare reform proposals are based. A change in UC's premium contribution policy between 1993 and 1994 created a unique natural experiment for investigating the effect of price on retirees' health insurance decisions. This study consists of two related analyses. First, I estimate the effect of changes in out-of-pocket premiums between 1993 and 1994 on the decision to switch plans during open enrollment. Second, using data from 1993 to 1996, I examine the extent to which rising premiums for fee-for-service Medigap coverage increased HMO enrollment among Medicare-eligible UC retirees. Price is a significant factor affecting the health plan decisions of Medicare-eligible UC retirees. However, these retirees are substantially less price sensitive than active UC employees and the non-elderly in other similar programs. This result is likely attributable to higher nonpecuniary switching costs facing older individuals. Although it is not clear exactly how price sensitive enrollees must be in order to generate price competition among health plans, the behavioral differences between retirees and active employees suggest that caution should be taken in extrapolating from research on the non-elderly to the Medicare program.
    Health Services Research 01/2001; 35(5 Pt 1):949-76. · 2.78 Impact Factor
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