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Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries.
Am J Med. 2005 Dec; 118(12):1392-400.AJ

Abstract

BACKGROUND

For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care.

OBJECTIVE

The objective was to compare the quality of care delivered by for-profit and not-for-profit health plans using Medicare Health Plan Employer Data and Information Set (HEDIS) clinical measures.

RESEARCH DESIGN

This was an observational study comparing HEDIS scores in for-profit and not-for-profit health plans that enrolled Medicare beneficiaries in the United States during 1997.

OUTCOME MEASURES

Outcome measures included health plan quality scores on each of 4 clinical services assessed by HEDIS: breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness.

RESULTS

The quality of care was lower in for-profit health plans than not-for-profit health plans on all 4 of the HEDIS measures we studied (67.5% vs 74.8% for breast cancer screening, 43.7% vs 57.7% for diabetic eye examination, 63.1% vs 75.2% for beta-blocker medication after myocardial infarction, and 42.1% vs 60.4% for follow-up after hospitalization for mental illness). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for 3 of the 4 measures (not beta-blocker medication after myocardial infarction). Different geographic locations of for-profit and not-for-profit health plans did not explain these differences.

CONCLUSION

By using standardized performance measures applied in a mandatory measurement program, we found that for-profit health plans provide lower quality of care than not-for-profit health plans. Special efforts to monitor and improve the quality of for-profit health plans may be warranted.

Authors+Show Affiliations

Department of Health Policy and Management, Harvard School of Public Health, USA. eschneid@hsph.harvard.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16378784

Citation

Schneider, Eric C., et al. "Quality of Care in For-profit and Not-for-profit Health Plans Enrolling Medicare Beneficiaries." The American Journal of Medicine, vol. 118, no. 12, 2005, pp. 1392-400.
Schneider EC, Zaslavsky AM, Epstein AM. Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries. Am J Med. 2005;118(12):1392-400.
Schneider, E. C., Zaslavsky, A. M., & Epstein, A. M. (2005). Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries. The American Journal of Medicine, 118(12), 1392-400.
Schneider EC, Zaslavsky AM, Epstein AM. Quality of Care in For-profit and Not-for-profit Health Plans Enrolling Medicare Beneficiaries. Am J Med. 2005;118(12):1392-400. PubMed PMID: 16378784.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries. AU - Schneider,Eric C, AU - Zaslavsky,Alan M, AU - Epstein,Arnold M, PY - 2005/01/13/received PY - 2005/05/04/revised PY - 2005/05/04/accepted PY - 2005/12/28/pubmed PY - 2006/2/25/medline PY - 2005/12/28/entrez SP - 1392 EP - 400 JF - The American journal of medicine JO - Am J Med VL - 118 IS - 12 N2 - BACKGROUND: For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care. OBJECTIVE: The objective was to compare the quality of care delivered by for-profit and not-for-profit health plans using Medicare Health Plan Employer Data and Information Set (HEDIS) clinical measures. RESEARCH DESIGN: This was an observational study comparing HEDIS scores in for-profit and not-for-profit health plans that enrolled Medicare beneficiaries in the United States during 1997. OUTCOME MEASURES: Outcome measures included health plan quality scores on each of 4 clinical services assessed by HEDIS: breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness. RESULTS: The quality of care was lower in for-profit health plans than not-for-profit health plans on all 4 of the HEDIS measures we studied (67.5% vs 74.8% for breast cancer screening, 43.7% vs 57.7% for diabetic eye examination, 63.1% vs 75.2% for beta-blocker medication after myocardial infarction, and 42.1% vs 60.4% for follow-up after hospitalization for mental illness). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for 3 of the 4 measures (not beta-blocker medication after myocardial infarction). Different geographic locations of for-profit and not-for-profit health plans did not explain these differences. CONCLUSION: By using standardized performance measures applied in a mandatory measurement program, we found that for-profit health plans provide lower quality of care than not-for-profit health plans. Special efforts to monitor and improve the quality of for-profit health plans may be warranted. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/16378784/Quality_of_care_in_for_profit_and_not_for_profit_health_plans_enrolling_Medicare_beneficiaries_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(05)00521-8 DB - PRIME DP - Unbound Medicine ER -