Comparison of health outcomes for male seniors in the Veterans Health Administration and Medicare Advantage plans.
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.
Selim
Alfredo J
AJ
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
Berlowitz
Dan
D
Kazis
Lewis E
LE
Rogers
William
W
Wright
Steven M
SM
Qian
Shirley X
SX
Rothendler
James A
JA
Spiro
Avron
A
Miller
Donald
D
Selim
Bernardo J
BJ
Fincke
Benjamin G
BG
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