Not-for-profit plans provide better quality care to Medicare beneficiaries in managed care
A recent study published by the American Journal of Medicine concludes that not-for-profit plans provide better quality care compared to for-profit plans for Medicare beneficiaries enrolled in Medicare+Choice, now called Medicare Advantage. The study examined four measures of clinical care quality included in the Medicare Health Plan Employer Data and information Set (HEDIS): breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness.
From Table 3:
HEDIS performance among for-profit and not-for profit health plans
|
|
For-profit |
Not-for-profit |
|
Breast cancer screening
|
67.5% |
74.8% |
|
Diabetic eye examination |
43.7% |
57.7% |
|
Beta blockers after myocardial infarction |
63.1% |
75.2% |
|
Follow-up after hospitalization for mental illness |
42.1% |
60.4% |
Even after controlling for sociodemographic case-mix, health plan characteristics, and geographic location, for-profit plans still performed worse than not-for-profits plans in three out of four clinical measures (not beta-blocker after myocardial infarction).
The authors note the relevance of these findings as 1) most health plans serving Medicare beneficiaries since 1999 have been for-profit, and 2) the measures evaluated are well accepted and known to reduce morbidity. Possible explanations for the difference in quality include for-profit plans’ lack of control over provider practices, and adverse financial incentives in the for-profit sector for controlling quality.
These findings, though they reflect data from 1998, reflect current concerns about managed care. The Medicare Modernization Act of 2003 has renewed the push toward managed care, despite concerns about whether quality and for-profit managed care can coexist. The authors urge continued monitoring of quality improvement as a part of any federal program.
_________________________
Schneider, Eric, Alan Zaslavsky, Arnold Epstein. “Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries.” American Journal of Medecine. (2005) 118, 1392-1400. Available at http://download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934305005218.pdf
© Copyright, Center for Medicare Advocacy, Inc. 01/08/2010