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Poor and elderly do worse in HMOs
Study before choosing health plan
October 1, 1996
Web posted at: 11:00 p.m. EDTSAN 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 Boston.
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 faster
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 plans.
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 chronically ill.
"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 attention
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 said.
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 said.
Correspondent Andrew Holtz and Reuters contributed to this report.
Related stories:
- Report: Plan to limit HMO doctor payments shelved - July 8, 1996
- Critics say HMOs hiding facts to save bucks - May 31, 1996
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