Variations in Medicare Health Maintenance Organizations

Article Abstract:

There is widespread variability in the services HMOs provide to Medicare beneficiaries. More and more Medicare patients are being enrolled in managed care. A 1999 study found that elderly women with breast cancer were more likely to receive recommended diagnostic tests and treatments in Medicare HMOs compared with similar fee-for-service settings. However, when individual HMOs were analyzed, substantial performance variations were found, including both favorable and unfavorable patterns of care. This could be caused by different business arrangements between doctors and HMOs and different ways of measuring quality.

Care and treatment, Editorial, Health maintenance organizations, Aged patients, Elderly patients

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How expensive is unlimited mental health care coverage under managed care?

Article Abstract:

Expanding mental health coverage in insurance plans to comply with the Mental Health Parity Act of 1996 will likely only cause minor increases in the costs to insurers. In a review of 24 managed-care mental health insurance plans, removing the annual limit of $25,000 for care would increase insurance payments one dollar. Removing limits on the number of covered visits to mental health professionals would increase payments less than seven dollars. Existing models of utilization patterns and expense substantially overestimate the cost of mental health insurance reform.

Economic aspects, Psychiatric services, Mental health services, Medical care, Cost of, Health care costs

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Exhaustion of Drug Benefits and Disenrollment of Medicare Beneficiaries From Managed Care Organizations

Article Abstract:

Many Medicare beneficiaries may switch to another managed care plan when their drug benefits are used up. Many managed care plans place limits on drug coverage, which may not be enough for many elderly people. A researcher analyzed enrollment data for 1998 from four health plans that placed limits on annual drug coverage. In all four plans, Medicare beneficiaries who had used up their drug benefits were twice as likely to disenroll as those who had not used up their drug benefits.

Drugs

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