Address correspondence to Jessica N. Mittler, Ph.D., Assistant Professor, Health Policy and Administration, The Pennsylvania State University, 604 Ford Building, University Park, PA 16802; e-mail: jnm14@psu.edu. Bruce E. Landon, M.D., M.B.A., M.Sc., Associate Professor of Health Care Policy and Medicine, is with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Elliot S. Fisher, M.D., M.P.H., Director, The Center for Health Policy Research, Professor of Medicine and Community and Family Medicine, is with the Dartmouth Medical School, Center for Health Policy Research, Lebanon, NH. Paul D. Cleary, Ph.D., Dean of Public Health, Chair, Epidemiology and Public Health, Anna M.R. Lauder, Professor of Public Health, is with the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT. Alan M. Zaslavsky, Ph.D., Professor of Health Care Policy, is with the Department of Health Care Policy, Harvard Medical School, Boston, MA.
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Market Variations in Intensity of Medicare Service Use and Beneficiary Experiences with Care
Article first published online: 6 APR 2010
DOI: 10.1111/j.1475-6773.2010.01108.x
© Health Research and Educational Trust
Additional Information
How to Cite
Mittler, J. N., Landon, B. E., Fisher, E. S., Cleary, P. D. and Zaslavsky, A. M. (2010), Market Variations in Intensity of Medicare Service Use and Beneficiary Experiences with Care. Health Services Research, 45: 647–669. doi: 10.1111/j.1475-6773.2010.01108.x
Publication History
- Issue published online: 3 MAY 2010
- Article first published online: 6 APR 2010
Keywords:
- Patient experiences with care;
- Medicare;
- small area variations;
- managed care;
- utilization
Objective. Examine associations between patient experiences with care and service use across markets.
Data Sources/Study Setting. Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index.
Study Design. We estimated correlations and linear regressions of eight measures of case-mix-adjusted beneficiary experiences with intensity of service use across markets.
Data Collection/Extraction. We merged CAHPS data with service use data, excluding beneficiaries under 65 years of age or receiving Medicaid.
Principal Findings. Overall, higher intensity use was associated (p<.05) with worse (seven measures) or no better care experiences (two measures). In higher-intensity markets, Medicare FFS and MA beneficiaries reported more problems getting care quickly and less helpful office staff. However, Medicare FFS beneficiaries in higher-intensity markets reported higher overall ratings of their personal physician and main specialist. Medicare MA beneficiaries in higher-intensity markets also reported worse quality of communication with physicians, ability to get needed care, and overall ratings of care.
Conclusions. Medicare beneficiaries in markets characterized by high service use did not report better experiences with care. This trend was strongest for those in managed care.