title: Differences in risk-adjusted mortality between medicaid-eligible patients enrolled in medicare advantage plans and those enrolled in the veterans health administration.
abstract: BACKGROUND
  We compared risk-adjusted mortality rates between Medicaid-eligible patients in the Medicare Advantage plans ("MA dual enrollees") and Medicaid-eligible patients in the Veterans Health Administration ("VHA dual enrollees").
  
  
  METHODS
  We used the Death Master File to ascertain the vital status of 1912 MA and 2361 VHA dual enrollees. We used Cox regression models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  The 3-year mortality rates of VHA and MA dual enrollees were 15.8% and 19.0%, respectively. The adjusted HR of mortality in the MA dual enrollees was significantly higher than in the VHA dual enrollees (HR, 1.260 [95% CI, 1.044-1.520]). This was also the case for elderly patients and those from racial/ethnic minority groups.
  
  
  CONCLUSIONS
  The VHA had better health outcomes than did MA plans. The VHA's performance is reassuring, given its emphasis on equal access to healthcare in an environment that is less dependent on patient financial considerations.
authors: Center for Health Quality, Outcomes, and Economic Research, VA Medical Center, Bedford, Massachusetts, 01730, USA. Selim.Alfredo_j@Boston.Med.Va.gov
authors: Alfredo J
authors: AJ
authors: Selim
authors: Lewis E
authors: LE
authors: Kazis
authors: Shirley
authors: S
authors: Qian
authors: James A
authors: JA
authors: Rothendler
authors: Avron
authors: A
authors: Spiro
authors: William
authors: W
authors: Rogers
authors: Samuel C
authors: SC
authors: Haffer
authors: Steven M
authors: SM
authors: Wright
authors: Donald
authors: D
authors: Miller
authors: Bernardo J
authors: BJ
authors: Selim
authors: Benjamin G
authors: BG
authors: Fincke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D020398:Medicare Part C; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016016:Proportional Hazards Models; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D055815:Young Adult