Since 2000, the Centers for Medicare & Medicaid Services (CMS) has
been collecting information on beneficiaries' experiences with health care
for Medicare managed care (MMC) and traditional fee-for-service (FFS) Medicare.
To compare beneficiary experiences with managed care and FFS arrangements
throughout the country and to assess the stability of those differences over
Design, Setting, and Participants
CMS administered managed care and FFS versions of the Consumer Assessment
of Health Plans Study (CAHPS) survey to samples of beneficiaries (aged ≥65
years) from Medicare + Choice MMC organizations and from geographic strata
within the traditional FFS Medicare program. We analyzed responses collected
in 2000 and 2001 from 497 869 respondents: 299 058 beneficiaries
enrolled in MMC plans (response rate, 82%) and 198 811 enrolled in FFS
Medicare (response rate, 68%). Differences between MMC and FFS within states
were assessed after adjustment for case mix and nonresponse. For estimates
at the regional and national level, state estimates were combined after weighting
by the MMC enrollment in the state.
Main Outcome Measures
Four overall ratings (of the plan, personal physician, care received
overall, and care received from specialists), 5 measures summarizing beneficiaries'
experiences with care (getting care needed; getting care quickly; communication
with clinicians; courtesy and respect of physician's office staff; and paperwork,
information, and customer service), and reports of receipt of 3 preventive
services (flu shots, pneumococcal vaccinations, and being advised to quit
smoking) were assessed.
Respondents in MMC and FFS plans were similar to each other and to the
Medicare population as a whole. Nationally, FFS Medicare beneficiaries rated
experiences with care measured by the CAHPS survey higher than did MMC beneficiaries;
for instance, in ratings of care received overall (scale of 1-10) (8.91 FFS
vs 8.86 MMC, P<.001, in 2000; and 8.88 FFS vs
8.78 MMC, P<.001, in 2001). Differences between
FFS and MMC varied across states, however. Managed care enrollees reported
significantly fewer problems with paperwork, information, and customer service
(2.62 FFS vs 2.55 MMC, P<.001, in 2000; and 2.59
FFS vs 2.51 MMC, P<.001, in 2001). Enrollees in
MMC were also more likely to report having received immunizations for influenza
and pneumococcus (from any source) (in 2000, 77% of MMC vs 63% of FFS respondents; P<.001), and smokers were more likely to report having
received counseling to quit smoking.
Our data suggest that managed care was better at delivering preventive
services, whereas traditional Medicare was better in other aspects of care
related to access and beneficiary experiences. These relative strengths should
be considered when policy decisions are made that affect the availability
of choice or influence beneficiaries to choose one model of care over another.