ACCESS AND OUTCOMES OF ELDERLY PATIENTS ENROLLED IN MANAGED CARE

Objective.-To determine differences in access to care and medical outc omes for Medicare patients with an acute or a chronic symptom who were enrolled in health maintenance organizations (HMOs) compared with sim ilar fee-for-service (FFS) nonenrollees. Design.-A 1990 household tele phone survey of Medicare beneficiaries who reported joint pain or ches t pain during the previous 12 months. Sample.-Stratified random sample of HMO enrollees (n=6476) and comparable sample of FFS Medicare benef iciaries (n=6381). Access and Outcome Measures.-Care-seeking behavior, physician visits, diagnostic procedures performed, therapeutic interv entions prescribed, follow-up recommended by a physician, and symptom response to treatment. Results.-After controlling for demographic fact ors, health and functional status, and health behavior characteristics , HMO enrollees with joint pain (n=2243) were more likely than nonenro llees (n=2009) to have a physician visit (odds ratio [OR], 1.19; 95% c onfidence interval [Cl], 1.03 to 1.38) and medication prescribed (OR, 1.35; 95% Cl, 1:14 to 1.60). Patients with chest pain who were enrolle d in HMOs (n=556) were less likely than nonenrollees (n=524) to have a physician visit (OR, 0.50; 95% Cl, 0.30 to 0.82). For both joint and chest pain, HMO enrollees were less likely to see a specialist for car e, have follow-up recommended, or have their progress monitored. There were no differences in complete elimination of symptoms, but HMO enro llees with continued joint pain reported less symptomatic improvement than nonenrollees (OR, 0.72; 95% Cl, 0.59 to 0.86). Conclusions.-Reduc ed utilization of services for patients with specific ambulatory condi tions was observed in HMOs with Medicare risk contracts, with less sym ptomatic improvement in one of the four outcomes studied.