Patient satisfaction among elderly enrollees and disenrollees in Medicare health maintenance organizations. Results from the National Medicare Competition Evaluation.

More than 1 million Medicare beneficiaries have enrolled in health maintenance organizations (HMOs) and competitive medical plans under a new program in which beneficiaries can freely enroll in a risk-based HMO in their area or remain in the fee-for-service sector under Medicare. Based on a randomly selected nationwide sample of beneficiaries, we analyzed differences in patient satisfaction between 2091 beneficiaries who were continuously enrolled in an HMO plan for 1 year and 1000 beneficiaries in the fee-for-service sector. We also studied the reasons for disenrollment. No significant difference in overall satisfaction was found between HMO enrollees and fee-for-service beneficiaries. However, HMO enrollees expressed less satisfaction compared with fee-for-service beneficiaries regarding the professional competence of their health care providers and the willingness of the HMO staff to discuss problems. On the other hand, HMO enrollees were more satisfied than fee-for-service beneficiaries with waiting times and claims processing. Approximately half of the disenrollment from an HMO within 1 year was attributed to misunderstanding the terms of enrollment.

[1]  P. Tugwell,et al.  Comparison of questionnaires determining patient satisfaction with medical care. , 1987, Health services research.

[2]  J. Iglehart.  Second thoughts about HMOs for Medicare patients. , 1987, The New England journal of medicine.

[3]  J. Newhouse,et al.  Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial. , 1986, Health services research.

[4]  F. A. Bryan,et al.  Choice of Payment Plan in the Medicare Capitation Demonstration , 1986, Medical care.

[5]  R. Penchansky,et al.  Relating Satisfaction With Access to Utilization of Services , 1984, Medical care.

[6]  J. Ware,et al.  Patient Satisfaction and Change in Medical Care Provider: A Longitudinal Study , 1983, Medical care.

[7]  T. Zastowny,et al.  Satisfaction With Medical Care: Replications and Theoretic Reevaluation , 1983, Medical care.

[8]  D. Mechanic,et al.  The Growth of HMOs: Issues of Enrollment and Disenrollment , 1983, Medical care.

[9]  R. Wersinger,et al.  Demographic Characteristics and Prior Utilization Experience of HMO Disenrollees Compared With Total Membership , 1982, Medical care.

[10]  B. Linn,et al.  Satisfaction With Ambulatory Care and Compliance in Older Patients , 1982, Medical care.

[11]  S. Greenfield,et al.  Patient Suffering and Patient Satisfaction Among the Chronically Ill , 1982, Medical care.

[12]  R. Wersinger,et al.  Factors Influencing Disenrollment From an HMO , 1981, Medical care.

[13]  T. Zastowny,et al.  Satisfaction with Medical Care: Its Measurement and Relation to Utilization , 1979, Medical care.

[14]  L L Kupper,et al.  Correlates of Satisfaction and Dissatisfaction with Medical Care: A Community Perspective , 1975, Medical care.

[15]  E. Freidson.  Prepaid group practice and the new "demanding patient". , 1973, The Milbank Memorial Fund quarterly. Health and society.

[16]  S. Stephens,et al.  Demographic and utilization characteristics of HMO disenrollees. , 1987, GHAA journal.

[17]  L. Rossiter,et al.  The entry of HMOs into the Medicare market: implications for TEFRA's mandate. , 1986, Inquiry : a journal of medical care organization, provision and financing.

[18]  Rossiter Lf,et al.  The entry of HMOs into the Medicare market: implications for TEFRA's mandate. , 1986 .

[19]  J E Ware,et al.  Defining and measuring patient satisfaction with medical care. , 1983, Evaluation and program planning.

[20]  J. Ware,et al.  Behavioral consequences of consumer dissatisfaction with medical care. , 1983, Evaluation and program planning.