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Some for-profit Medicare health plans provide lower quality of care than not-for-profit plans

A new study found that some for-profit Medicare health plans, which enroll the majority of Medicare beneficiaries, provide lower quality of care than not-for-profit plans. All Medicare health plans are required to report quality data using the Health Plan Employer Data and Information Set (HEDIS) each year to the National Committee for Quality Assurance. Researchers. Supported in part by the Agency for Healthcare Research and Quality (HS10803), researchers analyzed the 1998 HEDIS file for performance on four clinical quality indicators. This included data from 294 health plans serving 303,718 Medicare beneficiaries during 1997.

Nearly two-thirds (64 percent) of the study health plans were for-profit. The quality of care was lower in for-profit health plans than not-for-profit health plans on all four HEDIS quality indicators studied: 67.5 vs. 74.8 percent of eligible women screened for breast cancer; 43.7 vs. 57.7 percent of diabetics given an eye examination; 63.1 vs. 75.2 percent of heart attack victims given beta-blocker medication following their heart attack; and 42.1 vs. 60.4 percent of patients given followup care after hospitalization for mental illness.

Adjustment for sociodemographic case mix and health plan characteristics reduced, but did not eliminate, the differences, which remained significant for all measures except beta-blocker medication after heart attack. The authors caution that for-profit plans should not be banned from enrolling Medicare patients, since some for-profit plans were high-performing, and the care they provide may be better than that provided by Medicare fee-for-service.

See "Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries," by Eric C. Schneider, M.D. M.Sc., Alan M. Zaslavsky, Ph.D., and Arnold M. Epstein, M.D., M.A., in the December 2005 American Journal of Medicine 118, pp. 1392-1400.

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