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By analyzing the first mandatory reporting of Quality-of-Care (QOC) data for Medicare patients, researchers from the Department of Health Policy and Management, Harvard School of Public Health; and the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, found that for-profit plans provided significantly lower quality of care than not-for-profit plans.

Until 1997, QOC data came from surveys, was voluntarily provided by health plans, or came from regional plans. As such, some of these data may have been affected by biased selection and none of the data accounted for known geographic variation in the delivery of care. After 1997, reporting QOC data became mandatory in the Medicare program, thus providing nationwide data in the form of the Health Plan Employer Data and Information Set (HEDISTM). Using four measures of care, breast cancer screening, diabetic eye examination, beta-blocker medication after myocardial infarction, and follow-up after hospitalization for mental illness, the authors report that for-profit plans had lower ratings in all four measures than not-for-profit plans. Even after correcting for sociodemographic factors and health plan differences, for-profit plans still trailed not-for-profits in 3 of the 4 measures.

Writing in the article, Eric C. Schneider, MD, MSc, Alan M. Zaslavsky, PhD, and Arnold M. Epstein, MD state, "These results are particularly important for two reasons. First, since the late 1990s, the majority of health plans that have enrolled Medicare beneficiaries have been for profit. Second, the measures we studied are based on widely accepted standards of care for the clinical services they assess. There is a high degree of consensus that these clinical serv
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Contact: Pamela Poppalardo
ajmmedia@elsevier.com
212-633-3944
Elsevier Health Sciences
20-Dec-2005