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Managed care and Medicare reform

J B Oberlander1

  • 1School of Public Health, UC-Berkeley, CA 94720, USA. oberland@garnet.berkeley.edu

Journal of Health Politics, Policy and Law
|April 1, 1997
PubMed
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Medicare: still looking for solutions.

Health affairs (Project Hope)ยท1998
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Medicare reform proposals aim to shift beneficiaries to managed care plans, like health maintenance organizations (HMOs). Evidence suggests caution is needed due to concerns about care quality for chronically ill patients.

Area of Science:

  • Health Policy
  • Healthcare Management
  • Medicare Reform

Background:

  • Medicare reform proposals increasingly advocate for managed care plans, particularly Health Maintenance Organizations (HMOs).
  • Proponents claim these plans offer financial savings for the government and improved care quality/benefits for enrollees.
  • This analysis examines the arguments for and against managed care integration into Medicare.

Purpose of the Study:

  • To summarize claims for and against managed care in Medicare.
  • To review evidence on financial savings, benefits, and quality of care from Medicare's experience with HMOs.
  • To inform policy decisions regarding managed care adoption in Medicare.

Main Methods:

  • Literature review of claims and evidence regarding managed care in Medicare.

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  • Analysis of Medicare's experience with Health Maintenance Organizations (HMOs).
  • Examination of financial savings, benefits coverage, and quality of care metrics.

    • Main Results:

    • Evidence raises concerns about HMOs' ability to adequately care for chronically ill Medicare patients.
    • Significant uncertainty exists regarding the future performance of managed care plans.
    • HMOs may generate excessive payments due to favorable selection of healthier enrollees.

    Conclusions:

    • Policymakers should proceed cautiously with managed care adoption in Medicare.
    • Financial incentives, such as vouchers, to push beneficiaries into HMOs should be avoided.
    • Policies are needed to protect care quality, manage payments, and preserve the fee-for-service option.