title: Market variations in intensity of Medicare service use and beneficiary experiences with care.
abstract: OBJECTIVE
  Examine associations between patient experiences with care and service use across markets.
  
  
  METHODS
  Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index.
  
  
  METHODS
  We estimated correlations and linear regressions of eight measures of case-mix-adjusted beneficiary experiences with intensity of service use across markets.
  
  
  METHODS
  We merged CAHPS data with service use data, excluding beneficiaries under 65 years of age or receiving Medicaid.
  
  
  RESULTS
  Overall, higher intensity use was associated (p<.05) with worse (seven measures) or no better care experiences (two measures). In higher-intensity markets, Medicare FFS and MA beneficiaries reported more problems getting care quickly and less helpful office staff. However, Medicare FFS beneficiaries in higher-intensity markets reported higher overall ratings of their personal physician and main specialist. Medicare MA beneficiaries in higher-intensity markets also reported worse quality of communication with physicians, ability to get needed care, and overall ratings of care.
  
  
  CONCLUSIONS
  Medicare beneficiaries in markets characterized by high service use did not report better experiences with care. This trend was strongest for those in managed care.
authors.affiliation: Health Policy and Administration, The Pennsylvania State University, 604 Ford Building, University Park, PA 16802, USA. jnm14@psu.edu
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Mittler
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Elliot S
authors.initials: ES
authors.lastname: Fisher
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003142:Communication; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008389:Marketing of Health Services / Q000458:organization & administration*; D006278:Medicare / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011787:Quality of Health Care / Q000458:organization & administration*; D012017:Referral and Consultation; D020379:Risk Adjustment; D017062:Small-Area Analysis; D013727:Terminal Care; D013997:Time Factors; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data
references.citation: Health Aff (Millwood). 1988 Spring;7(1):33-48
references.pmid: 3360392
references.citation: N Engl J Med. 2008 Aug 7;359(6):643-50
references.pmid: 18687648
references.citation: Med Care. 2000 Feb;38(2):162-74
references.pmid: 10659690
references.citation: Ann Intern Med. 2003 Feb 18;138(4):288-98
references.pmid: 12585826
references.citation: Health Care Financ Rev. 2001 Spring;22(3):109-126
references.pmid: 25372572
references.citation: Arch Intern Med. 2005 Oct 24;165(19):2252-6
references.pmid: 16246991
references.citation: Int J Qual Health Care. 2001 Dec;13(6):481-8
references.pmid: 11769751
references.citation: Ann Intern Med. 2003 Feb 18;138(4):273-87
references.pmid: 12585825
references.citation: Health Serv Res. 2003 Dec;38(6 Pt 1):1509-27
references.pmid: 14727785
references.citation: Med Care. 2002 Jun;40(6):485-99
references.pmid: 12021675
references.citation: JAMA. 2004 Apr 14;291(14):1744-52
references.pmid: 15082702
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):w232-4
references.pmid: 19174384
references.citation: N Engl J Med. 2008 Sep 18;359(12):1200-2
references.pmid: 18799555
references.citation: Med Care Res Rev. 2000 Sep;57(3):379-94
references.pmid: 10981191
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1302-10
references.pmid: 16162577
references.citation: JAMA. 2008 May 28;299(20):2406-12
references.pmid: 18505950
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):w219-31
references.pmid: 19174383
references.citation: Health Serv Res. 2004 Aug;39(4 Pt 1):847-64
references.pmid: 15230931
references.citation: JAMA. 2003 Jan 15;289(3):305-12
references.pmid: 12525231
references.citation: Health Aff (Millwood). 2009 Jul-Aug;28(4):w719-29
references.pmid: 19556248
references.citation: Health Serv Res. 2004 Oct;39(5):1467-85
references.pmid: 15333118
references.citation: Med Care. 2002 Oct;40(10):951-64
references.pmid: 12395028
references.citation: Science. 1973 Dec 14;182(4117):1102-8
references.pmid: 4750608
references.citation: Ann Intern Med. 2006 May 2;144(9):641-9
references.pmid: 16670133
references.citation: Inquiry. 2000 Summer;37(2):146-61
references.pmid: 10985109
references.citation: Health Aff (Millwood). 2009 May-Jun;28(3):864-73
references.pmid: 19414899
references.citation: Health Aff (Millwood). 2004 Jan-Jun;Suppl Web Exclusives:W4-184-97
references.pmid: 15451981
references.citation: JAMA. 2000 Oct 4;284(13):1670-6
references.pmid: 11015797
references.citation: JAMA. 2001 May 23-30;285(20):2622-8
references.pmid: 11368736
references.citation: Health Care Financ Rev. 2001 Spring;22(3):101-107
references.pmid: 25372460
references.citation: Health Aff (Millwood). 1999 Nov-Dec;18(6):140-9
references.pmid: 10650696
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):w262-71
references.pmid: 19174388
references.citation: Med Care. 1999 Mar;37(3 Suppl):MS69-78
references.pmid: 10098561
references.citation: Health Aff (Millwood). 1998 Jul-Aug;17(4):80-94
references.pmid: 9691552
references.citation: Health Care Financ Rev. 2002 Summer;23(4):101-15
references.pmid: 12500473