Comparing mortality and time until death for medicare HMO and FFS beneficiaries.
OBJECTIVE
To compare adjusted mortality rates of TEFRA-risk HMO enrollees and disenrollees with rates of beneficiaries enrolled in the Medicare fee-for-service sector (FFS), and to compare the time until death for decedents in these three groups.


METHODS
Data are from the 124 counties with the largest TEFRA-risk HMO enrollment using 1993-1994 Medicare Denominator files for beneficiaries enrolled in the FFS and TEFRA-risk HMO sectors.


METHODS
A retrospective study that tracks the mortality rates and time until death of a random sample of 1,240,120 Medicare beneficiaries in the FFS sector and 1,526,502 enrollees in HMOs between April 1, 1993 and April 1, 1994. A total of 58,201 beneficiaries switched from an HMO to the FFS sector and were analyzed separately.


RESULTS
HMO enrollees have lower relative odds of mortality than a comparable group of FFS beneficiaries. Conversely, HMO disenrollees have higher relative odds of mortality than comparable FFS beneficiaries. Among decedents in the three groups, HMO enrollees lived longer than FFS beneficiaries, who in turn lived longer than HMO disenrollees.


CONCLUSIONS
Medicare TEFRA-risk HMO enrollees appear to be, on average, healthier than beneficiaries enrolled in the FFS sector, who appear to be in turn healthier than HMO disenrollees. These health status differences persist, even after controlling for beneficiary demographics and county-level variables that might confound the relationship between mortality and the insurance sector.
Maciejewski
M L
ML
Northwest Center for Outcomes Research in Older Adults, HSR&D, VA Puget Sound Health Care System, Seattle, WA 98108, USA.
Dowd
B
B
Call
K T
KT
Feldman
R
R
D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009026:Mortality; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States