Market variations in intensity of Medicare service use and beneficiary experiences with care.
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.
Mittler
Jessica N
JN
Health Policy and Administration, The Pennsylvania State University, 604 Ford Building, University Park, PA 16802, USA. jnm14@psu.edu
Landon
Bruce E
BE
Fisher
Elliot S
ES
Cleary
Paul D
PD
Zaslavsky
Alan M
AM
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
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