• Presentation

Beneficiary Health Status and Health Care Experiences: Differences between Medicare Advantage and Fee-for Service 2000-2003


Bernard, S. L., & Carpenter, L. A. (2005, December). Beneficiary Health Status and Health Care Experiences: Differences between Medicare Advantage and Fee-for Service 2000-2003. Presented at American Public Health Association Annual Meeting, Philadelphia, PA.


Study Design: Four annual cross-sectional surveys of nationally representative samples of Medicare beneficiaries. We analyzed effects of coverage type (Medicare Advantage=MA, Fee-for-service=FFS) on reports of health care experiences and how these effects vary by health status, using linear models that adjust for education, age, proxy response, and county of residence. Measures are six outcomes from the Consumer Assessments of Health Plans (CAHPS®) survey: three scales (Getting Needed Care, Good Communication, Getting Care Quickly), a 0-10 rating (Care Received), and two dichotomous measures of preventative services (received flu shot, received pneumonia shot). Comparisons were made within strata of respondents with "Poor/Fair", "Good", or "Very Good/Excellent" self-reported health status.

Population Studied: 610,231 MA and 220,584 FFS beneficiaries residing in the 617 counties in 40 states where beneficiaries had a choice between MA and FFS for 2000 through 2003. These counties represent more than 90% of the MA population and about half of the FFS population in any given year.

Results: Beneficiaries reported significantly (p<.05 usually="" p="" better="" experiences="" with="" ffs="" than="" ma="" for="" of="" comparisons="" years="" x="" scales="" health="" strata="" and="" ratings="" including="" beneficiaries="" rating="" their="" as="" or="" the="" only="" two="" which="" reported="" significantly="" were="" good="" in="" differences="" favor="" tended="" to="" be="" largest="" who="" described="" all="" measures="" but="" care="" quickly.="" these="" are="" fairly="" small="" median="" standard="" deviations="" four="" outcomes.="" effects="" exceed="" three="" getting="" comparison="" received="" immunizations="" more="" often="" pneumonia="" shots="" advantage="" over="" was="" greatest="" health.="">
Conclusions: Health Care experiences are quite positive for both MA and FFS beneficiaries, but are somewhat more positive for FFS beneficiaries for ratings and scales and somewhat better for MA for immunizations. Differences are greatest for those in "fair" or "poor" health. Efforts should be undertaken to improve access to care in MA and preventative care in FFS Medicare.