National Medicare Competition Evaluation: An Evaluation of the Quality of the Process of Care. Final Analysis Report

摘要

The study evaluates the quality of care received by Medicare beneficiaries who enrolled in health maintenance organizations (HMOs) through the National Medicare Competition Demonstrations and compares this with a fee-for-service group. Medical records were examined for samples of HMO enrollees and beneficiaries receiving care under the regular fee-for-service system of care. Beneficiaries process of care was examined for two resource intensive conditions (colorectal cancer and congestive heart failure), two chronic illnesses (diastolic hypertension and diabetes mellitus), and routine care in an outpatient setting. The study findings indicated that the HMO enrollees received medical care that was at least equal in quality to the care received by beneficiaries in the fee-for-service comparison group. In addition, there is evidence that HMOs provide better routine care for elderly patients.