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 of Medicare enrollees in HMOs and fee-for-service in 1994
Riley, GF., Chiang, YP., Ingber, M., & Tudor, CG. (1996). Health status of Medicare enrollees in HMOs and fee-for-service in 1994. Health Care Financing Review, 17(4), 65-76. http://www.cms.hhs.gov/HealthCareFinancingReview/PastArticles/itemdetail.asp?filterType=dual
Abstract
Publications Info
To contact an RTI author, request a report, or for additional information about publications by our experts, send us your request.
Meet the Experts
View All ExpertsRecent Publications
Article
Use of a web-based portal to return normal individual research results in Early Check
Article
Personal exposure to PM2.5 in different microenvironments and activities for retired adults in two megacities, China
Article
Estimating global artisanal fishing fleet responses in an era of rapid climate and economic change
Article