title: How do the experiences of Medicare beneficiary subgroups differ between managed care and original Medicare?
abstract: OBJECTIVE
  To examine whether disparities in health care experiences of Medicare beneficiaries differ between managed care (Medicare Advantage [MA]) and traditional fee-for-service (FFS) Medicare.
  
  
  METHODS
  132,937 MA and 201,444 FFS respondents to the 2007 Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) survey.
  
  
  METHODS
  We defined seven subgroup characteristics: low-income subsidy eligible, no high school degree, poor or fair self-rated health, age 85 and older, female, Hispanic, and black. We estimated disparities in CAHPS experience of care scores between each of these groups and beneficiaries without those characteristics within MA and FFS for 11 CAHPS measures and assessed differences between MA and FFS disparities in linear models.
  
  
  RESULTS
  The seven subgroup characteristics had significant (p<.05) negative interactions with MA (larger disparities in MA) in 27 of 77 instances, with only four significant positive interactions.
  
  
  CONCLUSIONS
  Managed care may provide less uniform care than FFS for patients; specifically there may be larger disparities in MA than FFS between beneficiaries who have low incomes, are less healthy, older, female, and who did not complete high school, compared with their counterparts. There may be potential for MA quality improvement targeted at the care provided to particular subgroups.
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Haviland
authors.forename: Nate
authors.initials: N
authors.lastname: Orr
authors.forename: Katrin
authors.initials: K
authors.lastname: Hambarsoomian
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D020398:Medicare Part C / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States