Comparison of S/HMO and TEFRA-Risk Plan Enrollees: Expenditures, Utilization ofServices, Health and Functional Status. Executive Summary, Final Report and Appendices

摘要

The purpose of this study is to compare cost and use of health care services andhealth and functional status measures for enrollees in a social health maintenance organization (S/HMO) and a TEFRA-risk Medicare HMO. Both plans are operated by the same parent HMO. In addition to the traditional Medicare services covered by the TEFRA plan, the S/HMO provides a long-term care benefit and case management services for chronic illness. Enrollees in the two plans use the same physicians and hospitals. Using an econometric correction for endogenous health plan selection by enrollees, the overall conclusion is that membership in the S/HMO versus the TEFRA HMO is associated with increased expenditures. The magnitude of the estimated increase in expenditures, and the results for use of inpatient services and health and functional status are very sensitive to the assumption regarding the variance of the error terms in the regression equations and somewhat sensitive to the distribution of errors in the estimated equations. Membership in the S/HMO does not appear to be associated either positively or negatively with health or functional status of enrollees.