Medicare and Managed Care: What Do Beneficiaries Need to Know?

Educating beneficiaries about Medicare options

Researchers from the University of Oregon determined the key types of knowledge necessary if Medicare beneficiaries are to make informed choices among expanded health plan options, including managed care plans that became available after passage of the Balanced Budget Act of 1997.

The study, conducted from 1998 to 1999, consisted of a series of in-depth telephone interviews and a follow-up mail survey with four groups: health services researchers, advocates, health plan executives and organizational representatives.

Key Findings

The study yielded consensus across all four groups on a core set of implications that are important for consumers to understand as they choose between managed care and fee-for-service Medicare options.

  • Potential advantages of managed care include:
    • Better coordination and continuity of care.
    • Protection from over-treatment.
    • Better quality.
    • Less burden on patients to manage their own care.
  • Potential disadvantages of managed care include:
    • The need for patients to advocate for themselves.
    • Reduced patient autonomy.
    • Reduced choice of providers.
    • Potential disruption of the existing patient-provider relationship.
  • Because of a lack of consensus on many other implications of managed care, the principal investigator concluded that further research was needed before clear and comprehensible educational materials could be developed.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $35,454.