Access and outcomes of elderly patients enrolled in managed care.
OBJECTIVE
To determine differences in access to care and medical outcomes for Medicare patients with an acute or a chronic symptom who were enrolled in health maintenance organizations (HMOs) compared with similar fee-for-service (FFS) nonenrollees.


METHODS
A 1990 household telephone survey of Medicare beneficiaries who reported joint pain or chest pain during the previous 12 months.


METHODS
Stratified random sample of HMO enrollees (n = 6476) and comparable sample of FFS Medicare beneficiaries (n = 6381). ACCESS AND OUTCOME MEASURES: Care-seeking behavior, physician visits, diagnostic procedures performed, therapeutic interventions prescribed, follow-up recommended by a physician, and symptom response to treatment.


RESULTS
After controlling for demographic factors, health and functional status, and health behavior characteristics, HMO enrollees with joint pain (n = 2243) were more likely than nonenrollees (n = 2009) to have a physician visit (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.03 to 1.38) and medication prescribed (OR, 1.35; 95% CI, 1.14 to 1.60). Patients with chest pain who were enrolled in HMOs (n = 556) were less likely than nonenrollees (n = 524) to have a physician visit (OR, 0.50; 95% CI, 0.30 to 0.82). For both joint and chest pain, HMO enrollees were less likely to see a specialist for care, have follow-up recommended, or have their progress monitored. There were no differences in complete elimination of symptoms, but HMO enrollees with continued joint pain reported less symptomatic improvement than nonenrollees (OR, 0.72; 95% CI, 0.59 to 0.86).


CONCLUSIONS
Reduced utilization of services for patients with specific ambulatory conditions was observed in HMOs with Medicare risk contracts, with less symptomatic improvement in one of the four outcomes studied.
Clement
D G
DG
Department of Health Administration, Virginia Commonwealth University, Richmond 23298-0203.
Retchin
S M
SM
Brown
R S
RS
Stegall
M H
MH
D000203:Activities of Daily Living; D000368:Aged; D002637:Chest Pain / Q000453:epidemiology / Q000628:therapy; D003625:Data Collection; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008329:Managed Care Programs / Q000592:standards / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D010146:Pain; D012959:Socioeconomic Factors; D014481:United States