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For-Profit Health Plans Offer Poorer Care to Medicare Beneficiaries

Independent research found they trailed non-profit plans in all four areas studied

TUESDAY, Dec. 20, 2005 (HealthDay News) -- For-profit health plans for Medicare beneficiaries provide significantly lower quality of care than non-profit health plans.

That's the conclusion of a Harvard study, in the December issue of the American Journal of Medicine, which noted that since the late 1990s, the majority of health plans that have enrolled Medicare beneficiaries have been for-profit.

Researchers analyzed data from the first mandatory reporting of Quality-of-Care (QOC) for Medicare patients, which began after 1997. The Harvard team looked at four measures of care: Breast cancer screening; diabetic eye examination; beta-blocker medication after a heart attack; and follow-up hospitalization after mental illness.

For-profit health plans had lower ratings in all four areas compared to the non-profit plans. For-profit plans still trailed in three of the four categories even after the researchers adjusted for enrollee sociodemographic factors and health plan differences.

"We found that the quality of care delivered to Medicare beneficiaries is substantially lower in for-profit health plans compared with not-for-profit health plans. Our findings are not only consistent with prior research but also reinforce the concern that the financial incentives of for-profit plans lead to less aggressive efforts to manage the quality of care," the authors wrote.

"These results are particularly important for two reasons. First, since the late 1990s, the majority of health plans that have enrolled Medicare beneficiaries have been for-profit," the study authors wrote. "Second, the measures we studied are based on widely accepted standards of care for the clinical services they assess. There is a high degree of consensus that these clinical services can reduce morbidity and mortality if beneficiaries receive them."

The researchers recommended that quality monitoring be a key element of the U.S. federal government's efforts to optimize the quality of health care for Medicare beneficiaries.

More information

The U.S. Agency for Healthcare Research and Quality has more about healthcare quality.

SOURCE: Elsevier Health Sciences, news release, Dec. 20, 2005
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