Patient Satisfaction Among Elderly Enrollees and Disenrollees in Medicare Health Maintenance Organizations

Abstract

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. (JAMA. 1989;262:57-63)