ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Wednesday, October 2, 1996 TAG: 9610020062
SECTION: NATIONAL/INTERNATIONAL PAGE: A-2 EDITION: METRO
DATELINE: CHICAGO
SOURCE: Associated Press
Poor and elderly people with diabetes, high blood pressure and heart problems do much worse under managed care than similar patients in traditional fee-for-service insurance plans, a study found.
Twice as many poor and elderly patients in managed care said their health had declined over a four-year period, according to the study in today's Journal of the American Medical Association.
Only one of five poor patients in managed care felt better after four years, compared with more than half of those in traditional plans.
John Ware Jr., a research psychologist at the New England Medical Center and author of the study, called the work ``an indictment of the whole notion that we are going to implement cost containment and it's going to be just as good for everybody.''
The study involved 1,574 patients in Chicago, Los Angeles and Boston who filled out health questionnaires in 1986 and again in 1990.
Despite his confidence in the strength of the findings, Ware cautioned that because the study covered only three large cities, its conclusions should not be assumed to apply to other cities or to rural areas.
The self-reporting method was criticized by Susan Pisano of the American Association of Health Plans, which represents 1,000 managed-care plans. She said medical evaluations should have been used instead.
Also, Pisano said, managed-care plans have greatly improved their care of the poor and elderly since the study ended in 1990.
Managed-care plans try to cut costs by discouraging unnecessary procedures. Patients pay a set fee for a doctor who acts as the gatekeeper and must authorize further treatment or referrals to a specialist.
Millions of Americans belong to health maintenance organizations, one of the most popular forms of managed care. Millions of people covered by Medicare are joining HMOs, which then receive their fees from the government.
The study found that the average patient - relatively young and not poor - fared equally well in managed-care and traditional plans. But the story was different for the poor and elderly.
Patients were studied with any of four chronic conditions - high blood pressure, non-insulin-dependent diabetes, a recent heart attack and congestive heart failure. Four years apart, they filled out questionnaires.
Fifty-four percent of patients 65 and older who were treated in HMOs reported a decline in health, compared with 28 percent of those in fee-for-service plans. Only 22 percent of poor patients treated in HMOs reported improvement after four years, compared with 57 percent with traditional insurance.
Among HMO patients who were both elderly and poor, 68 percent reported a decline in health, compared with 27 percent in fee-for-service.
The pattern was the same for all the conditions studied, in all three cities.
Ware theorized that elderly and poor patients treated in HMOs received less care. The study illustrates that ``not all HMOs are created equal'' and managed-care plans must address the fact that the elderly and poor tend to need more care, not less, he said.
This week's JAMA also includes a study that found rheumatoid arthritis patients in Northern California did just as well in managed care as in fee-for-service; a report showing no significant length-of-stay differences for critically ill patients in managed care and fee-for-service plans in Massachusetts; and California research suggesting that hospitals are used less in areas with lots of HMOs.
LENGTH: Medium: 68 linesby CNB