Once viewed as a panacea to the nation’s health care problems, HMOs have fallen out of favor. Commercially insured patients who flooded into HMOs, or managed care, in the early 1990s left in droves by the end of the decade. Medicaid patients, however, don’t always have the luxury of choosing their health plans, and the proportion of Medicaid beneficiaries enrolling in HMOs continues to increase.
A new study by researchers at Harvard Medical School and Harvard School of Public Health shows that under HMOs, Medicaid patients fare worse than commercial HMO patients on 10 of 11 quality measures. Though policymakers once hoped that HMOs would eliminate the quality-of-care gap between the Medicaid and commercial populations, this clearly hasn’t happened.
“There was a lot of hope that managed care would eliminate disparities between the Medicaid population and the commercial population,” says Bruce Landon, an associate professor at Harvard Medical School and first author on the paper, which appeared in the Journal of the American Medical Association Wednesday (Oct. 10). “HMOs may have moved care in that direction, but there is still a gap in the care that Medicaid and commercial patients receive.”
Using data from 383 health plans, the researchers looked at four groups:
The study did not include Medicaid patients who are not enrolled in managed care, so it is certainly possible that HMOs serve the Medicaid population better than traditional Medicaid. But HMOs do not eliminate the quality-of-care gap between Medicaid patients and the commercial population.
The researchers measured care in three main areas — prevention and screening, chronic disease management, and care for pregnant women — and discovered striking differences. For example, female Medicaid beneficiaries receive 25 percent less postpartum care than their commercial counterparts, and Medicaid patients with diabetes were 15 percent more likely to have unacceptable blood sugar levels than their commercial counterparts.
“Part of the gap might be explained by the patients themselves, for it’s possible that the Medicaid population is less able to adhere to doctors’ recommendations than the commercial population,” says Landon, who is also an associate professor of medicine at the Beth Israel Deaconess Medical Center. “But I suspect Medicaid patients may also fare worse because they visit doctors and hospitals of lower quality.”
“This study suggests that policymakers must develop new, novel strategies if we are going to eliminate the quality-of-care gap between the Medicaid and commercial populations,” adds Epstein, who is also a professor of medicine at Brigham and Women’s Hospital.
This research was supported by a grant from the Robert Wood Johnson Foundation.