Medicare health maintenance organizations and traditional coverage: perceptions of health care among beneficiaries with disabilities

OBJECTIVE: To determine whether perceptions of access to, affordability of, and quality of health care services differ for Medicare beneficiaries with disabilities in health maintenance organizations (HMOs) and traditional Medicare coverage. DESIGN: Bivariate and multivariate analyses were conducted to determine the relationship between Medicare coverage type and perceptions of health care access, affordability, and quality. SETTING: Noninstitutionalized Medicare beneficiaries across the United States. PARTICIPANTS: A random sample of 6116 beneficiaries who qualify for Medicare as working-age disabled (n = 2250), or who qualify as elderly and have at least 1 instrumental activities of daily living limitation (n = 3866). This subsample of the nationally representative Medicare Current Beneficiary Survey (MCBS) represents 11,627,107 beneficiaries with disabilities. INTERVENTION: Questions about perception of access to primary care, affordability of care, and quality of care. Data derived from the 1994 MCBS Access to Care File. MAIN OUTCOME MEASURES: Dependent variables: perceptions of access to primary care, affordability, and satisfaction with quality of care. Independent variables: indicators of managed care status and health status level, severity of disability, Medicare qualification, age, and gender. RESULTS: Beneficiaries with disabilities in HMOs perceive better access to primary care services, and greater affordability of health services than those with traditional Medicare coverage. Beneficiaries in poor health or with the most severe disabilities were most likely to perceive access and cost difficulties, regardless of coverage type. CONCLUSION: Medicare managed care appears generally to be meeting 2 of its goals-better access to primary care and more affordable care-though these advantages are not being shared by those with poor health status and/or severe disabilities.