Are managed care medicare beneficiaries with chronic conditions satisfied with their care?

Objectives: This article compares patient experiences of chronically ill older people in health maintenance organizations (HMOs) with other forms of Medicare supplemental coverage. Method: Using data from the 1996 Medicare Current Beneficiaries Survey, the authors analyzed the experiences of chronically ill elderly with overall quality, access to care, and physicians' technical, interpersonal, and information-giving skills. Logistic models controlled for prevalent chronic conditions, functioning, perceived health status, sociodemographics, region of residence, and countylevel Medicare HMO penetration. Results: Satisfaction with quality of overall care and physicians' skills was more likely for many conditions for those with private fee for service and Medicaid supplemental coverage, compared to Medicare HMO population. No insurance effects were found among elders who had none of the examined conditions. Discussion: Managed care may have negatively affected patients' perceptions of overall quality of care and doctor-patient interaction. Including additional and supplementary services to the delivery of care may improve satisfaction rates.