CHANGING HEALTH CARE EXPERIENCES AND PERSPECTIVES OF OLDER ADULTS: COMPARISON OF HMO AND FEE-FOR-SERVICE ENROLLEES

Abstract

This paper examines the health care experiences of older adults over a five-year period, including continuity in care, changes in health insurance coverage, and satisfaction with care.

Face-to-face interviews were conducted annually with 415 older adults (mean age = 84, range = 72–105), 100 of whom were originally health maintenance organization (HMO) subscribers and 315 of whom were receiving fee-for-service care. Several predictors of health care experiences were examined, including personal characteristics, health status and health care variables. Coverage type (HMO or fee-for-service) was the most consistent predictor. HMO subscribers were more likely than fee-for-service recipients to experience changes in insurance (both negative and positive changes) and discontinuity in physician care, although satisfaction with care did not vary among HMO and non-HMO members. Two-thirds of HMO subscribers and nearly one-third of fee-for-service recipients reported changes in insurance coverage over the five-year study period. In terms of perspectives on HMO care, the most frequently mentioned advantage of HMO care among those in HMOs was diminished costs, while fee-for-service subscribers did not believe there were any advantages to being in an HMO. Those not in HMOs viewed loss of physician choice and poor quality care as major disadvantages of HMOs. Results of this study demonstrate that older adults commonly experience changes in their health care coverage and physician care. They adapt to these changes through positive appraisals of the type of case they receive.

Citation

Kahana, E., Dan, A., Kahana, B., Kercher, K., Seçkin, G. and Stange, K. (2004), "CHANGING HEALTH CARE EXPERIENCES AND PERSPECTIVES OF OLDER ADULTS: COMPARISON OF HMO AND FEE-FOR-SERVICE ENROLLEES", Jacobs Kronenfeld, J. (Ed.) Chronic Care, Health Care Systems and Services Integration (Research in the Sociology of Health Care, Vol. 22), Emerald Group Publishing Limited, Leeds, pp. 65-80. https://doi.org/10.1016/S0275-4959(04)22004-X