Quality assessments by sick and healthy beneficiaries in traditional Medicare and Medicare managed care.
BACKGROUND
The Centers for Medicare & Medicaid Services pays for services provided through traditional fee-for-service (FFS) Medicare and managed care plans (Medicare Advantage [MA]). It is important to understand how financing and organizational arrangements relate to quality of care.


OBJECTIVE
To compare care experiences and preventive services receipt in traditional Medicare and MA for healthy and sick beneficiaries.


METHODS
Randomly selected beneficiaries responded to the 2003 and 2004 Consumer Assessments of Healthcare Providers and Systems (CAHPS(R)) surveys. We analyzed 237,221 MA responses (80% response rate) and 153,535 from FFS (68% response rate). We compared case-mix-adjusted CAHPS scores between FFS and MA for healthy and sick beneficiaries on 7 CAHPS measures of care experiences and 3 preventive service measures.


RESULTS
CAHPS scores were lower in MA than FFS for all care experience measures except office wait time. The sick had less favorable care experiences than the healthy for all measures, but were more likely to receive each preventive service (P < 0.001). FFS-MA differences were larger for the sick than the healthy for 5 of 7 experience measures (P < 0.05), and were twice as large for physician ratings and interactions. Office wait time and rates of immunization were better in MA than FFS (P < 0.001), with no differences between healthy and sick groups.


CONCLUSIONS
Beneficiaries in health plans report less favorable care experiences than those in FFS, particularly among the sick, but preventive service measures are higher in MA. The Centers for Medicare and Medicaid Services should strengthen efforts to improve care experiences of the sick, particularly in MA, and preventive service receipt in FFS.
Keenan
Patricia S
PS
Division of Health Policy and Administration, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut v, USA. patricia.keenan@yale.edu
Elliott
Marc N
MN
Cleary
Paul D
PD
Zaslavsky
Alan M
AM
Landon
Bruce E
BE
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000592:standards; D012959:Socioeconomic Factors; D014481:United States