Utilization of Services in Medicare Advantage versus Traditional Medicare since the Passage of the Medicare Modernization Act

摘要

Enrollment in Medicare Advantage has grown rapidly from 2003 to today. For the years 2003–2009, we compared individual-level Healthcare Effectiveness Data and Information Set (HEDIS®) data collected from all plans on service utilization by patients enrolled in Medicare Advantage HMO plans with comparable claims-based measures for matched samples from traditional Medicare. Controlling for self-reported health, health plan enrollees had lower rates of ambulatory visits and hospitalizations initially that converged by 2008 and fewer emergency department visits and ambulatory procedures (~25–30%). Health plan enrollees received fewer hip or knee replacements (lower by ~10%) but more coronary bypass surgery. Our study suggests utilization of services may be more appropriate in Medicare Advantage.