Poor and elderly do worse in HMOs
Study before choosing health plan
October 1, 1996
Web posted at: 11:00 p.m. EDT
SAN FRANCISCO (CNN) -- Many of the poor
and the elderly may fare worse in some
health maintenance organizations than
in fee-for-service programs, according
to a new study.
Patients who were neither poor nor old
seemed to do just as well in HMO's as
in traditional health insurance plans,
the study said.
Poor and elderly patients "were twice
as likely to decline in physical health
over a four-year period in an HMO in
comparison with fee-for-service plans,"
said research team leader John Ware, of
the New England Medical Center in
People choosing among health plans need
more objective information about the
health of patients in those plans,
researchers concluded in findings
published in this week's Journal of the
American Medical Association.
Pressure to see more patients
The researchers studied 2,235 patients
in Boston, Chicago and Los Angeles from
1986 to 1990. The patients, ages 18 to
97, suffered from chronic illnesses
including hypertension, recent acute
myocardial infarction and depressive
disorder. The results were similar for
each of the three study sites.
The study found that among patients
aged 65 and older treated under
Medicare, declines in physical health
over a four-year period were about
twice as common in HMOs as in fee-based
Patients in the low-income group also
had worse physical outcomes in HMOs
than in fee-based plans, they said.
Those with mental health problems,
however, did better in HMOs.
The study did not explain the
differences, though some doctors point
to demands to see more patients faster,
which may be counterproductive for the
"When you have people in internal
medicine who have multiple medical
problems, there's no way you can get
through everything in 10 or 15
minutes," said Dr. Marc Seltman.
Only one in five of the poor patients
was on Medicaid. Researchers found no
difference between HMO's and fee-for-
service plans for Medicaid patients,
but they say there were too few
patients in the different Medicaid
plans to be sure of the results.
A spokesperson for the HMO industry
disputed the researchers' methods, and
pointed out that the study looked at
treatment given in the late 1980's.
Government paying close
Health and Human Services Secretary
Donna Shalala said every plan providing
Medicare or Medicaid coverage should
meet the same standards.
"We're moving very rapidly into quality
measures, so that Americans can control
their own health care and have a better
sense of which plan will provide them
with quality health care," Shalala
Medicare and Medicaid officials are
starting to ask some of the same
questions the researchers used.
"We think it's important to look at
outcome in terms that matter most to
the public, in terms of what they are
able to do and how they feel," Ware
Correspondent Andrew Holtz and
Reuters contributed to this report.
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