Fee-for-Service Versus Managed Care Plan Performance: A Longitudinal Study of Medicare Patients' Self-reported Health Status

An increasing number of Medicare beneficiaries are enrolling in managed care programs such as Medicare Advantage Organizations (MAOs) as opposed to traditional fee-for-service (FFS) Medicare. As the entire Medicare population starts to expand policymakers and researchers have once again turned their attention to performance measurement in health plans and health care delivery systems. Despite recent developments in quality of care measurement, there are few studies that have focused on comparing the health outcomes of patients enrolled in one Medicare delivery system as opposed to another. The primary focus of this study was to compare two-year changes in self-reported health for elderly Medicare beneficiaries enrolled in a managed care plan (MAO) versus FFS Medicare. Medicare Health Outcomes Survey (MHOS) data from 1998-2000 were used to evaluate three separate health outcome measures: a) a mental and physical health measure, based on the Medicare Outcomes Study (MOS) SF-36 questionnaire, b) a general health measure, and c) a functional status measure, using the number of activities of daily living (ADLs) that a beneficiary was unable to perform. These three measures were collected for each survey respondent at baseline and follow-up (two years later) as part of the study's longitudinal research design. Ordinal and binary logistic regression analyses were conducted to determine the effect of Medicare delivery system on the likelihood of reporting worse health at follow-up. Results showed that elderly Medicare beneficiaries who were enrolled in an MAO were no more likely to report worse health for the physical health, general health and functional status measures than similar beneficiaries enrolled in FFS Medicare. There was however a negative association found with patient's self-reported mental health and enrollment in an MAO. This relationship was even more pronounced when the sample population was limited to persons with chronic conditions. This study also found that beneficiaries enrolled in for-profit MAOs and loosely managed HMOs were more likely to report worse health at follow-up than their counterparts in different types of plans. Findings from this study suggest that elderly Medicare patients report disparate levels of health which may be partially attributable to their choice to enroll in an MAO versus Medicare FFS, and additionally (where applicable), the type of MAO plan selected