title: Comparison of health outcomes for male seniors in the Veterans Health Administration and Medicare Advantage plans.
abstract: OBJECTIVE
  To compare the Veterans Health Administration (VHA) with the Medicare Advantage (MA) plans with regard to health outcomes.
  
  
  METHODS
  The Medicare Health Outcome Survey, the 1999 Large Health Survey of Veteran Enrollees, and the Ambulatory Care Survey of Healthcare Experiences of Patients (Fiscal Years 2002 and 2003).
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  Men 65+ receiving care in MA (N=198,421) or in VHA (N=360,316). We compared the risk-adjusted probability of being alive with the same or better physical (PCS) and mental (MCS) health at 2-years follow-up. We computed hazard ratio (HR) for 2-year mortality.
  
  
  RESULTS
  Veterans had a higher adjusted probability of being alive with the same or better PCS compared with MA participants (VHA 69.2 versus MA 63.6 percent, p<.001). VHA patients had a higher adjusted probability than MA patients of being alive with the same or better MCS (76.1 versus 69.6 percent, p<.001). The HRs for mortality in the MA were higher than in the VHA (HR, 1.26 [95 percent CI 1.23-1.29]).
  
  
  CONCLUSIONS
  Our findings indicate that the VHA has better patient outcomes than the private managed care plans in Medicare. The VHA's performance offers encouragement that the public sector can both finance and provide exemplary health care.
authors.affiliation: Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Memorial Hospital (152), Building 70, 200 Springs Road, Bedford, MA 01730, USA. alfredo.selim2@va.gov
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Selim
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
authors.forename: William
authors.initials: W
authors.lastname: Rogers
authors.forename: Steven M
authors.initials: SM
authors.lastname: Wright
authors.forename: Shirley X
authors.initials: SX
authors.lastname: Qian
authors.forename: James A
authors.initials: JA
authors.lastname: Rothendler
authors.forename: Avron
authors.initials: A
authors.lastname: Spiro
authors.forename: Donald
authors.initials: D
authors.lastname: Miller
authors.forename: Bernardo J
authors.initials: BJ
authors.lastname: Selim
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Fincke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D019538:Health Care Surveys; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D020398:Medicare Part C; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs