Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration.
BACKGROUND
Comparing health outcomes with adequate methodology is central to performance assessments of health care systems. We compared the Medicare Advantage Program (MAP) and the Veterans Health Administration (VHA) with regard to changes in health status and mortality.


METHODS
We used the Death-Master-File for vital status and the Short-Form 36 to determine physical (PCS) and mental (MCS) health at baseline and at 2 years. We compared the probability of being alive with the same or better (than would be expected by chance) PCS (or MCS) at 2 years and mortality, while adjusting for case-mix. Given the geographic variations in MAP enrollment, we did a regional sub-analysis.


RESULTS
There were no significant differences in the probability of being alive with the same or better PCS except for the South (VHA 65.8% vs. MAP 62.5%, P = .0014). VHA patients had a slightly higher probability than MAP patients of being alive with the same or better MCS (71.8% vs. 70.1%, P = .002) but no significant regional variations. The hazard ratios for mortality in the MAP were higher than in the VHA across all regions.


CONCLUSIONS
With the use of appropriate methodology, we found small differences in 2-year health outcomes that favor the VHA.
Selim
Alfredo J
AJ
Center for Health Quality, Outcomes, and Economic Research, A Health Services Research and Development Field Program, VA Medical Center, Bedford, MA, USA. Selim_Alfredo_J@Boston.Med.VA.gov
Kazis
Lewis E
LE
Rogers
William
W
Qian
Shirley X
SX
Rothendler
James A
JA
Spiro
Avron
A
Ren
Xinhua S
XS
Miller
Donald
D
Selim
Bernardo J
BJ
Fincke
Benjamin G
BG
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D006278:Medicare; D008603:Mental Health; D009026:Mortality / Q000639:trends*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D015397:Program Evaluation; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs