How Do the Experiences of Medicare Beneficiary Subgroups Differ between Managed Care and Original Medicare?

RAND Corporation, Santa Monica, CA, USA.
Health Services Research (Impact Factor: 2.78). 02/2011; 46(4):1039-58. DOI: 10.1111/j.1475-6773.2011.01245.x
Source: PubMed


To examine whether disparities in health care experiences of Medicare beneficiaries differ between managed care (Medicare Advantage [MA]) and traditional fee-for-service (FFS) Medicare.
132,937 MA and 201,444 FFS respondents to the 2007 Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) survey.
We defined seven subgroup characteristics: low-income subsidy eligible, no high school degree, poor or fair self-rated health, age 85 and older, female, Hispanic, and black. We estimated disparities in CAHPS experience of care scores between each of these groups and beneficiaries without those characteristics within MA and FFS for 11 CAHPS measures and assessed differences between MA and FFS disparities in linear models.
The seven subgroup characteristics had significant (p<.05) negative interactions with MA (larger disparities in MA) in 27 of 77 instances, with only four significant positive interactions.
Managed care may provide less uniform care than FFS for patients; specifically there may be larger disparities in MA than FFS between beneficiaries who have low incomes, are less healthy, older, female, and who did not complete high school, compared with their counterparts. There may be potential for MA quality improvement targeted at the care provided to particular subgroups.

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    • " different hospital staff work conditions , and lower pay for nonphysician staff in for - profit hospitals com - pared with nonprofit and government hospitals , as reported previously in the literature ( Arrington and Haddock 1990 ; Kessler and McClellan 2000 ; Bacon , Hughes , and Mark 2009 ) . Alternatively , recent work in outpatient settings ( Elliott et al . 2011 ) suggests that managed care forms of Medicare ( Medicare Advantage ) have bigger gender gaps than those in fee - for - service Medicare . Because a similar pattern was found for other groups whose care , like women ' s , tends to be more costly ( Owens 2008 ) , cost considerations may play a similar role in for - profit hospitals . Fut"
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    Health Services Research 02/2012; 47(4):1482-501. DOI:10.1111/j.1475-6773.2012.01389.x · 2.78 Impact Factor
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