A paradigm shift in the Golden Years . The transition from Federal Medicare to managed care Medicare, /

Abstract

Traditional federal Medicare, which provides health insurance coverage for approximately 13% of the national population, spent $213 billion in 1997. Due to medical advances, escalating healthcare costs and the rising senior population, the existing Medicare program is predicted to be bankrupt by the year 200 I. In an attempt to prevent this, the u.s. Department of Health and Human Services enacted legislation to allow commercial insurance plans to offer a managed care Medicare option. Because of low out-of-pocket costs and the extensive use of prevention programs associated with managed care Medicare, senior citizens are rapidly converting to these plans. It is important, then, to examine the quality of healthcare offered by both managed care Medicare and the traditional Medicare plan. This observational study used a descriptive correlational research design composed of a convenience sampling of Allegheny County, PA senior citizens attending community based, congregate senior centers. An adaptation of the Consumer Assessment of Health Plan Survey was used to determine perceptions of quality of care and sociodemographic variables. Using a proportional odds model, it was revealed in the data that the overall quality rating for type of insurance plan was predicted by the rating of physicians' skills, the perception that the plan provided the services needed, the amount oftime the physician spent with the subject and education level. The overall plan rating for managed care Medicare was 4.22 (s.d=0.76) whereas federal Medicare was 2.95 (s.d.=1.39). This data supports the hypothesis that subjects insured by managed care Medicare believe that they are provided with a quality of medical care better than that provided by federal Medicare.