Managed Care for Elderly People: A Compendium of Findings
dc.contributor.author | Miller, Edward | en_US |
dc.contributor.author | Weissert, William | en_US |
dc.contributor.author | Chernew, Michael E. | en_US |
dc.date.accessioned | 2010-04-13T18:35:22Z | |
dc.date.available | 2010-04-13T18:35:22Z | |
dc.date.issued | 1998 | en_US |
dc.identifier.citation | Miller, Edward; Weissert, William; Chernew, Michael (1998). "Managed Care for Elderly People: A Compendium of Findings." American Journal of Medical Quality 13(3): 127-140. <http://hdl.handle.net/2027.42/66514> | en_US |
dc.identifier.issn | 1062-8606 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/66514 | |
dc.description.abstract | Although managed care seems to serve well the in terests of non-elderly enrollees and their payers, elderly people face more risks. Chronic conditions, multiple prob lems, and more limited resources make them more vul nerable, whereas multiple payer sources make them more complicated to cover. This synthesis of managed care de livered in Medicare and Medicaid demonstration projects serving elderly beneficiaries shows that managed care plans either select or attract enrollees who suffer fewer frailties than those served in fee-for-service settings, ex hibit reluctance to enter rural markets, provide a broad range of elderly-specific services, offer more compre hensive coverage and services, and result in greater per ceived access problems, particularly for vulnerable subgroups. Plans operate more cheaply by using fewer resources, even after adjusting for case mix differences. Managed care enrollees tend to be more satisfied with financial and coverage aspects, whereas fee-for-service enrollees report higher satisfaction on other dimensions. In acute care settings, process of care findings were mixed, whereas clinical and self-reported outcome indi cators were no better and in some instances worse in managed care. Long-term care enrollees, in the few stud ies reported, consistently faired worse in both the processes and outcomes of care. These findings suggest that further research on the effects of managed care in its rapidly changing incarnations is needed, particularly with respect to how to improve the quality of acute and long-term care delivered to elderly people and the proper role of government and other key actors in the health care system. | en_US |
dc.format.extent | 3108 bytes | |
dc.format.extent | 2296604 bytes | |
dc.format.mimetype | text/plain | |
dc.format.mimetype | application/pdf | |
dc.publisher | Sage Publications | en_US |
dc.title | Managed Care for Elderly People: A Compendium of Findings | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbsecondlevel | Public Health | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | University of Michigan, Ann Arbor, Michigan | en_US |
dc.contributor.affiliationum | University of Michigan, Ann Arbor, Michigan | en_US |
dc.contributor.affiliationum | University of Michigan, Ann Arbor, Michigan | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/66514/2/10.1177_106286069801300304.pdf | |
dc.identifier.doi | 10.1177/106286069801300304 | en_US |
dc.identifier.source | American Journal of Medical Quality | en_US |
dc.identifier.citedreference | Vladeck BC, King KM Medicare at 30: Preparing for the future. JAMA 1995;274:259-262. | en_US |
dc.identifier.citedreference | Darman R. Comprehensive Health Reform: Observations about the Problem and Alternative Approaches to Solution. Presented to the House Committee on Ways and Means, October 10, 1991. | en_US |
dc.identifier.citedreference | The Board of Trustees, Federal Hospital Insurance Trust Fund. 1996 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund. Washington, DC, @ www.HCFA. gov, June 5 1996. | en_US |
dc.identifier.citedreference | Stoeckle JD The citadel cannot hold: Technologies go outside the hospital, patients and doctors too. Milbank Q 1995;73:3-17. | en_US |
dc.identifier.citedreference | Institute of Medicine. Improving the Quality of Care in Nursing Homes. Washington, DC: National Academy Press, 1986. | en_US |
dc.identifier.citedreference | Blendon RJ, Donelan K., Hill C., et al. Medicaid beneficiaries and health reform. Health Aff 1993;12:132-143. | en_US |
dc.identifier.citedreference | Weissert CS Medicaid in the 1990s: Trends, innovations, and the future of the 'PAC-Man' of state budgets. Publis: The Journal of Federalism 1992;22:93-109. | en_US |
dc.identifier.citedreference | Weissert WG, Cready CM, Pawelak JE The past and future of home- and community-based long-term care. Milbank Mem Fund Q 1988;66:309-388. | en_US |
dc.identifier.citedreference | Weissert WG, Hedrick SC Lessons learned from research on effects of community-based long-term care. J Am Geriatr Soc 1994;42:348-353. | en_US |
dc.identifier.citedreference | Wagner ER Types Of Managed Care Organizations. In: Kongstvedt PR, ed. Essentials of Managed Health Care. Galthersburg, MD: Aspen Publishers, 1995. | en_US |
dc.identifier.citedreference | Miller RH, Luft HS Managed care plan performance since 1980: A literature analysis. JAMA 1994;271:1512-1519. | en_US |
dc.identifier.citedreference | Physician Payment Review Commission (PPRC). Annual Report to Congress 1997. Washington, DC: PPRC, 1997. | en_US |
dc.identifier.citedreference | Langwell KM, Hadley JP Capitation and the Medicare program: History, issues, and evidence. Health Care Financ Rev 1986;Annual Supplement:9-20. | en_US |
dc.identifier.citedreference | Brown RS, Clement DG, Hill JW, et al. Do health maintenance organizations work for Medicare? Health Care Financ Rev 1993; 15:7-23. | en_US |
dc.identifier.citedreference | Harrington C., Newcomer RJ Social Health Maintenance Organizations: Service use and costs, 1985-89. Health Care Financ Rev 1991;12:37-52. | en_US |
dc.identifier.citedreference | Wrightson CW, Mc Call N. Cost analyses of the Arizona Health Care Cost Containment System: Lessons from an eleven-year evaluation. A Health Econ Health Serv Res 1995;15:79-97. | en_US |
dc.identifier.citedreference | Mc Call N., Wrightson CW, Korb J. et al. Evaluation of Arizona's Health Care Cost Containment System Demonstration. Final Report. San Francisco, CA: Laguna Research Associates, February 1996. | en_US |
dc.identifier.citedreference | Irvin K., Riley T., Booth M., et al. Managed Care for the Elderly: A Profile of Current Initiatives. Portland, ME: The Center for Health Policy Development, National Academy for State Health Policy, November 1993. | en_US |
dc.identifier.citedreference | Eng CE, Pedulla J., Eleazer GP, et al. Program of All-Inclusive Care for the Elderly (PACE): An innovative model of integrated geriatric care and financing. J Am Geriatr Soc 1997;45:223-232. | en_US |
dc.identifier.citedreference | Garfinkel SA, Schlenger WE, Mc Leroy KR, et al. Choice of payment plan in the Medicare Capitation Demonstration. Med Care 1986;24:628-640. | en_US |
dc.identifier.citedreference | Mc Combs JS, Kasper JD, Riley GF Do HMOs reduce health care costs? A multivariate analysis of two Medicare HMO demonstration projects. Health Serv Res 1990:25:593-613. | en_US |
dc.identifier.citedreference | Rossiter LF, Nelson LM, Adamache KM Service use and costs for Medicare beneficiaries in risk-based HMOs and CMPs: Some interim results from the National Medicare Competition Evaluation. Am J Public Health 1988;78:937-943. | en_US |
dc.identifier.citedreference | Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. Am J Public Health 1990;80:411-415. | en_US |
dc.identifier.citedreference | Retchin SM, Brown B. Management of colorectal cancer in Medicare health maintenance organizations. J Gen Intern Med 1990;5:110-114. | en_US |
dc.identifier.citedreference | Retchin SM, Brown B. Elderly patients with congestive heart failure under prepaid care. Am J Med 1991;90:236-242. | en_US |
dc.identifier.citedreference | Retchin SM, Preston J. Effects of cost containment on the care of elderly diabetics. Arch Intern Med 1991;151:2244-2248. | en_US |
dc.identifier.citedreference | Retchin SM, Clement DG, Rossiter LF, et al. How the elderly fare in HMOs: Outcomes from the Medicare Competition Demonstrations. Health Serv Res 1992;27:651-669. | en_US |
dc.identifier.citedreference | Brown RS, Hill JW The effects of Medicare risk HMOs on Medicare costs and service utilization. In: Luft HS, ed. HMOs and the Elderly. Ann Arbor, MI: Health Administration Press, 1994. | en_US |
dc.identifier.citedreference | Retchin SM, Clement DG, Brown RS Care of patients hospitalized with strokes under the Medicare risk program. In: Luft HS, ed. HMOs and the Elderly. Ann Arbor, MI: Health Administration Press, 1994. | en_US |
dc.identifier.citedreference | Hellinger FJ Selection bias in health maintenance organizations: Analysis of recent evidence. Health Care Financ Rev 1987;9:55-63. | en_US |
dc.identifier.citedreference | Riley GF, Lubitz J., Rabey E. Enrollee health status under Medicare risk contracts: An analysis of mortality rates. Health Serv Res 1991;26:137-163. | en_US |
dc.identifier.citedreference | Lichtenstein R., Thomas JW, Adams-Watson J., et al. Selection bias in TEFRA at-risk HMOs. Med Care 1991;29:318-331. | en_US |
dc.identifier.citedreference | Riley G., Tudor C., Chiang Y., et al. Health Status of Medicare enrollees in HMOs and fee-for-service in 1994. Health Care Financ Rev 1996;17:65-76. | en_US |
dc.identifier.citedreference | Wisner CR, Feldman R., Dowd B. The Twin Cities Medicare Health Plans Market: Choice, cost, and health status. In: Luft HS, ed. HMOs and the Elderly. Ann Arbor, MI: Health Administration Press, 1994. | en_US |
dc.identifier.citedreference | Iversen LH, Oberg CN, Polich CL The availability of long-term care services for Medicare beneficiaries in health maintenance organizations. Med Care 1988;26:918-925. | en_US |
dc.identifier.citedreference | Ricketts TC, Slifkin RT, Johnson-Webb KD. Patterns of health maintenance organization service areas in rural counties. Health Care Financ Rev 1995;17:99-113. | en_US |
dc.identifier.citedreference | HMO-PPO Digest 1995. Kansas City, MI: Hoechst Marion Roussell, Inc., 1995. | en_US |
dc.identifier.citedreference | Hurley RE, Bannick RR Utilization managers in Medicare Risk Contract HMOs: From control to collaboration. Qual Rev Bull 1993;19:131-137. | en_US |
dc.identifier.citedreference | Friedman B., Kane RL HMO medical directors' perceptions of geriatric practice in Medicare HMOs. J Am Geriatr Soc 1993;41:1144-1149. | en_US |
dc.identifier.citedreference | Fox PD, Heinen L., Kramer AM, et al. Initiatives in Service Delivery for the Elderly in HMOs. Prepared for The Robert Wood Johnson Foundation. Washington, DC : Lewin/ICF, 1991. | en_US |
dc.identifier.citedreference | Eppig FJ, Poisal JA Prescribed medicines: A comparison of FFS with HMO enrollees. Health Care Financ Rev 1996;17:213-214. | en_US |
dc.identifier.citedreference | Nelson L., Gold M., Brown R. Access to Care in Medicare Managed Care: Results from a 1996 Survey Enrollees and Disenrollees, Selected Research Series, No. 7. Washington DC: Physician Payment Review Commission, November 1996. | en_US |
dc.identifier.citedreference | Zarabozo C., Taylor C., Hicks J. Medicare managed care: Numbers and trends. Health Care Financ Rev 1996;17:243-261. | en_US |
dc.identifier.citedreference | Riley GF, Potosky AL, Lubitz JD Stage of cancer diagnosis for Medicare HMO and fee-for-service enrollees. Am J Public Health 1994;84:1598-1604. | en_US |
dc.identifier.citedreference | Carlisle DM, Siu AL, Keeler EB, et al. HMO vs FFS care of older persons with acute myocardial infarction. Am J Public Health 1992;82:1626-1630. | en_US |
dc.identifier.citedreference | Clement DG, Retchin SM, Brown RS, et al. 1994. Access and outcomes of elderly patients enrolled in managed care. JAMA 1994;271:1487-1492. | en_US |
dc.identifier.citedreference | Ware JE Jr, Bayliss MS, Rogers WH, et al. 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. JAMA 1996;276:1039-1047. | en_US |
dc.identifier.citedreference | Shaughnessy PW, Schlenker RE, Hittle DF Home health care outcomes under capitated and fee-for-service payment. Health Care Financ Rev 1994;16:187-221. | en_US |
dc.identifier.citedreference | Wan Tth. The effect of managed care on health services use by dually eligible elders. Med Care 1989;27:983-1001. | en_US |
dc.identifier.citedreference | Mc Call N., Jay ED, West R. Access and satisfaction in the Arizona Health Care Cost Containment System. Health Care Financ Rev 1989;11:63-77. | en_US |
dc.identifier.citedreference | Mc Call N., Turner P., Wrightson CW, et al. Evaluation of the Arizona Health Care Cost Containment System Demonstration: First Outcome Report. San Francisco, CA : Laguna Research Associates, July 1991. | en_US |
dc.identifier.citedreference | Newcomer R., Manton K., Harrington C., et al. Case mix controlled service use and expenditures in the Social/Health Maintenance Organization Demonstration. J Geront A Biol Sci Med Sci 1995;50A:M35-M44. | en_US |
dc.identifier.citedreference | Newcomer R., Harrington C., Preston S. Satisfaction in the Social/Health Maintenance Organization: A comparison of members, disenrollees, and those in fee-for-service. In: Luft HS, ed. HMOs and the Elderly. Ann Arbor, MI: Health Administration Press, 1994. | en_US |
dc.identifier.citedreference | Manton KG, Newcomer RJ, Lowrimore GR et al. Social/Health Maintenance Organization and fee-for-service health outcomes over time. Health Care Financ Rev 1993;15:173-202. | en_US |
dc.identifier.citedreference | Branch LG, Coulam RF, Zimmerman YA The PACE evaluation. Initial findings. Gerontologist 1995;35:349-359. | en_US |
dc.identifier.citedreference | Weissert WG, Lesnick T., Musliner M., et al. Cost-savings from home and community based services: Arizona's capitated Medicaid long-term care program. J Health Pol Policy Law 1991;22:1329-1357. | en_US |
dc.identifier.citedreference | Dawson D., Hendershot G., Fulton J. Aging in the eighties: Functional limitations of individuals age 65 years and over. In: Advanced Data From Vital and Health Statistics, No 133. Hyattsville, MD: National Center for Health Statistics, June 1987; 10. | en_US |
dc.identifier.citedreference | Weissert WG, Scanlon WJ, Wan Tth, et al. Care for the chronically ill: Nursing home incentive payment experiment. Health Care Financ Rev 1983;5:41-49. | en_US |
dc.identifier.citedreference | Weissert WG, Wan T., Livieratos B., et al. Effects and costs of day-care services for the chronically ill: A randomized experiment. Med Care 1980;18:567-584. | en_US |
dc.identifier.citedreference | Carcagno GJ Kemper P. The evaluation of the National Long Term Care Demonstration. 1. An overview of the channeling demonstration and its evaluation. Health Serv Res 1988;23:1-22. | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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