Market variations in intensity of Medicare service use and beneficiary experiences with care

Abstract

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.

Figure 1

Patient Reported Experiences Negatively Related to Intensity of Service Use in Medicare Advantage (MA) and Fee-for-Service (FFS) Notes. Larger versions of these and additional figures depicting the relationship between patient experience measures with intensity of service use are available in Appendix SA2, available at http://www.hsr.org. FFS, and dashed regression line (----); MA, and solid regression line (—); Q, quintile of intensity index. Intensity index is the 2003 end-of-life expenditure index (EOL-EI).

Figure 2

Patient Reported Experiences Negatively Related to Intensity of Service Use in Medicare Advantage (MA) But Not Fee-for-Service (FFS) Notes. Larger versions of these and additional figures depicting the relationship between patient experience measures with intensity of service use are available in Appendix SA2, available at http://www.hsr.org. FFS, and dashed regression line (----); MA, and solid regression line (—); Q, quintile of intensity index. Intensity index is the 2003 end-of-life expenditure index (EOL-EI).