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MEDICARE PATIENTS MAY WANT TO CONSIDER MANAGED CARE OPTION
Managed care organizations in Wisconsin are currently negotiating with the federal government to offer health maintenance organizations (HMO's) as an option to Wisconsin Medicare recipients.
Managed competition is one potential way for the government to save money and provide quality health care at the same time.
But is it a reasonable alternative for older adults?
"There were reports out that older patients don't fare as well in managed care as in traditional fee-for-service programs," said Roberta Riportella-Muller, University of Wisconsin-Madison/Extension health policy specialist.
"You always worry that sick people may not get all the care they need when the organization providing care has a limited budget. However, the data in that particular report is old. Therealso is evidence that older adults in HMO's are receiving better care now. These organizations have gained useful experience working with an older population."
Riportella-Muller said one of the biggest advantages for older adults in choosing managed care is it ends out-of-pocket expenses for the patient.
In managed care programs, the government pays the Medicare premium. Then, the patient has access to a wide range of services, often including prescriptions with only a small co-payment. Many managed care plans also include vision and dental visits.
"Your doctor visits, prescriptions, hospitalizations are all covered, and there's no paper work for you to file. It's all handled by the HMO," Riportella-Muller said.
Other advantages of managed care for Medicare patients includes: A decreased need for supplemental health insurance, because most services are covered in the basic plan.
Many physicians in private practice already contract with managed care organizations. That means patients would not necessarily have to give up their existing doctors in order to join a managed care plan.
"We're in an era of change where you are never certain who your provider will be," Riportella-Muller said. "When choosing managed care, you have a system in place that you can go to for everything. Potentially, you have all the answers because they know whom you should be referred to for specific problems.
There's a system in place to help you navigate through the often confusing world of health care." Riportella-Muller said a potential disadvantage of managed care for some Medicare recipients is that you no longer can make self-referrals without your primary care doctor's approval.
"That's not necessarily a negative thing, though. In managed care, there's a system in place to help you navigate through the often confusing world of health care," Riportella-Muller said.
(written Jan. 1997)
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