The apparent health status of Medicare beneficiaries in HMOs, a highly charged political issue, depends very much on the study, it turns out.
Three separate studies, released last week, produced different takes on the matter. Depending on the study, Medicare beneficiaries who receive coverage through HMOs are:
(A) as healthy as beneficiaries with traditional Medicare coverage;
(B) healthier than other beneficiaries;
(C) regardless of their health status, really fond of Medicare HMOs.
If Medicare beneficiaries in HMOs are as healthy as others, that's an argument for paying HMOs as least as much as standard fees because their costs to arrange care are higher.
But if HMOs draw healthier beneficiaries, that's justification for paying them less than standard fees. Theorectically, with healthier enrollees, their costs should end up less.
The first study was commissioned by the American Association of Health Plans, which represents HMOs. It found that Medicare beneficiaries in Florida enrolled in HMOs are as healthy as other beneficiaries.
The second study, published in the New England Journal of Medicine, accused HMOs of "cherry-picking" the healthiest seniors for enrollment in their plans, leaving out less healthy and costlier beneficiaries. It was conducted by researchers at the George Washington University School of Public Health and Health Services and the University of Miami School of Medicine.
Finally, in a survey of 5,932 retirees, 68% reported that they are extremely or very satisfied with their Medicare HMO. That survey was sponsored by CareData Reports, benefits consulting firm Towers Perrin and more than 30 employers.