Preferences for patient cost sharing among medicare beneficiaries after HMO plan withdrawals.
OBJECTIVE
To assess Medicare beneficiaries' willingness to cost share in order to minimize disruptions in coverage from HMO plan withdrawals.


METHODS
Cross-sectional survey of Medicare beneficiaries from February 1999 to March 1999.


METHODS
Ten U.S. counties with the highest HMO plan withdrawal rates.


METHODS
Seven hundred one Medicare beneficiaries for response rate of 69%.


RESULTS
Percentage of respondents willing to accept more out-of-pocket costs in order to continue their Medicare HMO coverage. Most respondents (67%) were willing to pay more out-of-pocket costs so that their HMO could have continued Medicare coverage. Those who were white (P =.03), had higher incomes (P =.01), and returned to traditional fee-for-service Medicare (P =.004) were more likely than other respondents to accept increased patient cost sharing. Most beneficiaries preferred Medicare policies requiring HMOs to sign longer-term Health Care Financing Administration (HCFA) contracts (72%) and to offer coverage to beneficiaries regardless of where they lived in a given state (87%). However, respondents' preferences for such policy options were not associated with the amount of cost sharing that respondents were willing to accept.


CONCLUSIONS
Most Medicare beneficiaries are willing to accept increased patient cost sharing in order to reduce disruptions in their HMO coverage. Policies intended to reduce HMO plan withdrawals, such as requiring health plans to sign longer-term HCFA contracts, are supported by many Medicare beneficiaries, but these policy preferences were not related to willingness to cost share. In light of an apparent willingness to pay more out-of-pocket medical costs, Medicare beneficiaries in general may accept increased cost sharing in order to retain their HMO coverage.
Kao
Audiey C
AC
Received from the Institute for Ethics, American Medical Association, Chicago, Ill 60610, USA. audiey_kao@ama-assn.org
Krasny
Alex J
AJ
D000367:Age Factors; D000368:Aged; D003266:Continuity of Patient Care; D017047:Cost Sharing; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations; D006304:Health Status; D006801:Humans; D008297:Male; D006278:Medicare; D017060:Patient Satisfaction; D012044:Regression Analysis; D012959:Socioeconomic Factors