Medicaid Managed Care - U.S. Senate Special Committee on Aging

Original Contributions
157
Differences in 4-Year Health Outcomes
for Elderly and Poor, Chronically Ill
Patients Treated in HMO and
Fee-for-Service Systems
Results From the Medical Outcomes Study
John E. Ware, Jr, PhD: Martha S. Bayliss. MSc: William H. Rogers, PhD: Mark Kosinski, MA, Alvin R. Tarlov. MD
Objective.-To compare physical and mental health outcomes of chronically ill ENROLLMENTS in health mainte-
adults, including elderly and poor subgroups, treated in health maintenance organance organizations (HMOs) have innization
(HMO) and fee-for-service (FFS) systems.
creased nearly 10-fold since 1976, and in
Study Design.-A 4-year observational study of 2235 patients (18 to 97 years some regions of the country, half of pri-
of age) with hypertension, non-insulin-dependent diabetes mellitus (NIDDM), revately
insured Americans are enrolled
cent acute myocardial infarction, congestive heart failure, and depressive disorder
in HMOs.M Polies at the state and fed-
sampled from HMO and FFS systems in 1986 and followed
eral
up
levels
through
seek
1990.
to
Those
affect a similar shift
aged 65 years and older covered
for those who
under
are
Medicare
publicly
and
insured,
low-income
in-
patients (200%No
of
cluding
poverty) were
both
analyzed
Medicare
separately.
and <strong>Medicaid</strong>.
Congress has signed legislation that will
Setting and Particdpants.-Offices of physicians practicing family medicine, in- give Medicare patients strong financial
temal medicine, endocrinology, cardiology, and psychiatry, in HMO and FFS sys- incentives to enroll in managed care
tems of care. Types of practices included both prepaid group (72% of patients) and plans. Yet, as documented in a recent
independent practice association (28%) types of HMOs. large mulispecialty literature analysis, little is known about
groups, and solo or small, single-specialty practices in Boston, Mass, Chicago, Ill, health outcomes in HMOs for the elder-
and Los Angeles, Calif.
ly and the poor, who have historically
Outcome Measures.-Differences between initial and 4-year follow-up scores
tended to favor fee-for-service (FFS)
of summary physical and mental health scales from
over
the
HMO
Medical
systems.
Outcomes Study
36-Item Short-Form Health Survey
The Medical
(SF-36)
Outcomes
for all patients
Study (MOS)
and practice settings. was fielded to compare 4-year health
Reaufts.-On average, physical health declined and mental health remained outcomes for chronically ill patients
stable during the 4-year follow-up period, with physical decdines largerforthe elderly treated in well-establshed HMOs and
than for the nonelderly (P