Social/health maintenance organization and fee-for-service health outcomes over time.
Evaluating the performance of long-term care (LTC) demonstrations requires longitudinal assessment of multiple outcomes where selective mortality and disenrollment, if not accounted for, can give the appearance of reduced (or enhanced) efficacy. We assessed outcomes in social/health maintenance organizations (S/HMOs) and Medicare fee-for-service (FFS) care using a multivariate model to estimate active life expectancy (ALE). S/HMO enrollees and samples of FFS clients in four sites were analyzed and outcome differences assessed for a 3-year period. Results provide insights into S/HMO performance under different conditions and, more generally, into evaluating LTC demonstrations without randomized client and control groups.
Duke University, Center for Demographic Studies, Durham, NC 27708.
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Manton
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Lowrimore
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Harrington
D000203:Activities of Daily Living; D000368:Aged; D002204:Capitation Fee / Q000592:standards; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008017:Life Expectancy; D008134:Long-Term Care / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D015233:Models, Statistical; D009026:Mortality; D016896:Treatment Outcome; D014481:United States