Health status of Medicare enrollees in HMOs and fee-for-service in 1994.
Riley, Gerald F
Date of Pub
Chiang, Yen P; Ingber, Melvin J; Tudor, Cynthia G
We compared the health status of 863 health maintenance organization (HMO) enrollees with that of 4,576 non-enrollees, controlling
for demographics and area of residence, using 1994 data from the Medicare Current Beneficiary Survey (MCBS). HMO respondents
were less likely to report fair or poor health, functional impairment, or heart disease. Average predicted costs based on
various health-status measures were substantially lower for HMO respondents than for respondents in fee-for-service (FFS)
arrangements. The Medicare payment formula for HMOs does not adequately adjust for the better health and consequent lower
expected costs of HMO enrollees. The addition of health-status measures would improvement payment accuracy and reduce average
HMO payments significantly below current levels.
Health Status Indicators : Activities of Daily Living : Aged : Capitation Fee : Comparative Study : Fee-for-Service Plans/utilization
: Female : Health Care Surveys : Health Maintenance Organizations/utilization : Human : Longitudinal Studies : Male : Medicare/utilization
: Rate Setting and Review : United States