With encouragement from the federal government, there has been steady growth in the number
of Medicare beneficiaries enrolled in health maintenance organizations
(HMOs) during the past 2 decades.1 The Balanced Budget Act
of 1997 has further expanded managed care alternatives through the
establishment of the Medicare+Choice program, and HMO enrollment may be
one third of the Medicare population by 2005.2 However,
thus far, the overall assessment about the quality of care in Medicare
HMOs has been inconclusive.3
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