Health outcomes. New quality measure for Medicare

Objective. A new measurement of health care quality for Medicare beneficiar ies has been implemented by the Health Care Financing Administration (HCFA) . This paper describes the program, presents baseline data and highlights a ssociated issues. Design. The Health Outcomes Survey (HOS) is a longitudinal cohort mail surv ey Changes in population health status after 2 years will be evaluated on a n individual plan level. Setting. Two-hundred and eighty-seven US Medicare managed care plans. Main outcomes measures. Physical component and mental component summary sca les derived from the SF-36. Findings. Baseline data documented lower health status in older populations , while functional limitations and disease prevalence were higher. Among di fferent plans, mean functional levels were found to be similar, although a few plans contained populations with exceptionally low levels. These data d o not support the assertion that enrolees in for-profit plans are healthier than non-profit plans. Conclusions/implications. The HOS is the first large-scale program to evalu ate health outcomes among older Americans. HCFA recognizes several technica l and policy issues. Technical issues include possible biased reporting for subpopulations, the validity of prosy responses and respondent burden. Pol icy issues concern the appropriateness of using a generic measure such as t he SF-36 and how much change in health status can be attributed to quality of health care. HCFA plans to extend the HOS to beneficiaries in traditiona l Medicare. The HOS project is expected to encourage more efforts to mainta in or improve the health status of the Medicare managed care population.