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The Elderly and Poor in the Medical Outcomes Study

Paul H. Barrett Jr, MD, MSPH; Peter Juhn, MD, MPH
JAMA. 1996;276(24):1952. doi:10.1001/jama.1996.03540240030018.
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To the Editor.  —The report of health outcomes for elderly and poor, chronically ill patients1 provoked alarming headlines in the lay press: "Aged, Poor Fare Worse in HMOs, Study Says."2 However, the data presented by the authors support neither the conclusions of the article nor the subsequent headlines. We are especially troubled by this study's potential negative impact on the physician-patient relationships of the nation's 3.6 million Medicare risk beneficiaries.Our major concern about this study is the unequivocal language regarding the association between prepaid financing and worse health outcomes. In this study, changes in average physical and mental health scores were not statistically significant across either the age or poverty categories. Presumably, the sample size estimate was based on this analysis. It is the standard approach to analyzing such data, and it showed no difference. For this finding to be omitted from the "Results" section of the


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