MediCaring: development and test marketing of a supportive care benefit for older people.
OBJECTIVE
To develop an alternative healthcare benefit (called MediCaring) and to assess the preferences of older Medicare beneficiaries concerning this benefit, which emphasizes more home-based and supportive health care and discourages use of hospitalization and aggressive treatment. To evaluate the beneficiaries' ability to understand and make a choice regarding health insurance benefits; to measure their likelihood to change from traditional Medicare to the new MediCaring benefit; and to determine the short-term stability of that choice.


METHODS
Focus groups of persons aged 65+ and family members shaped the potential MediCaring benefit. A panel of 50 national experts critiqued three iterations of the benefit. The final version was test marketed by discussing it with 382 older people (men > or = 75 years and women > or = 80 years) in their homes. Telephone surveys a few days later, and again 1 month after the home interview, assessed the potential beneficiaries' understanding and preferences concerning MediCaring and the stability of their responses.


METHODS
Focus groups were held in community settings in New Hampshire, Washington, DC, Cleveland, OH, and Columbia, SC. Test marketing occurred in New Hampshire, Cleveland, OH; Columbia, SC, and Los Angeles, CA.


METHODS
Focus group participants were persons more than 65 years old (11 focus groups), healthcare providers (9 focus groups), and family decision-makers (3 focus groups). Participants in the in-home informing (test marketing group) were persons older than 75 years who were identified through contact with a variety of services.


METHODS
Demographics, health characteristics, understanding, and preferences.


RESULTS
Focus group beneficiaries between the ages of 65 and 74 generally wanted access to all possible medical treatment and saw MediCaring as a need of persons older than themselves. Those older than age 80 were mostly in favor of it. Test marketing participants understood the key points of the new benefit: 74% generally liked it, and 34% said they would take it now. Preferences were generally stable at 1 month. In multivariate regression, those preferring MediCaring were wealthier, more often white, more often living in senior housing, and using more homecare services. However, they were not more often in poor health or needing ADL assistance.


CONCLUSIONS
Older persons aged more than 80 years can understand a health benefit choice; most liked the aims of a new supportive care benefit, and 34% would change immediately from Medicare to a supportive care benefit such as MediCaring,. These findings encourage further development of special programs of care, such as MediCaring, that prioritize comfort and support for the old old.
Lynn
J
J
The Center to Improve Care of the Dying, George Washington University, Washington, DC 20037, USA.
O'Connor
M A
MA
Dulac
J D
JD
Roach
M J
MJ
Ross
C S
CS
Wasson
J H
JH
D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001294:Attitude to Health; D032882:Comprehension; D005260:Female; D017144:Focus Groups; D006291:Health Policy; D006299:Health Services for the Aged / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007342:Insurance Benefits; D008297:Male; D008389:Marketing of Health Services; D006278:Medicare; D013727:Terminal Care / Q000191:economics* / Q000379:methods; D014481:United States