title: Cost and outcomes of Medicare reimbursement for HMO preventive services.
abstract: Medicare beneficiaries enrolled in a health maintenance organization (HMO) were randomized to a preventive services benefit package for 2 years or to usual care. At 24- and 48-month follow-ups, the treatment group had completed more advance directives, participated in more exercise, and consumed less dietary fat than the control group. Unexpectedly, more deaths occurred in the treatment group. Surviving treatment-group enrollees reported higher satisfaction with health, less decline in self-rated health status, and fewer depressive symptoms than surviving control participants. Despite these changes, the intervention did not yield lower cost per quality-adjusted life year in this historically prevention-oriented HMO.
authors.affiliation: Department of Health Services, H689, Box 357660, University of Washington, Seattle, WA 98195-7660, USA. donald@u.washington.edu
authors.forename: D L
authors.initials: DL
authors.lastname: Patrick
authors.forename: D
authors.initials: D
authors.lastname: Grembowski
authors.forename: M
authors.initials: M
authors.lastname: Durham
authors.forename: S A
authors.initials: SA
authors.lastname: Beresford
authors.forename: P
authors.initials: P
authors.lastname: Diehr
authors.forename: J
authors.initials: J
authors.lastname: Ehreth
authors.forename: J
authors.initials: J
authors.lastname: Hecht
authors.forename: J
authors.initials: J
authors.lastname: Picciano
authors.forename: W
authors.initials: W
authors.lastname: Beery
mesh_terms: D000368:Aged; D015438:Health Behavior; D006279:Health Maintenance Organizations / Q000191:economics* / Q000592:standards; D006305:Health Status Indicators; D006801:Humans; D006278:Medicare / Q000592:standards*; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011314:Preventive Health Services / Q000191:economics* / Q000592:standards; D019057:Quality-Adjusted Life Years; D014481:United States / Q000453:epidemiology; D014861:Washington / Q000453:epidemiology