Market variations in intensity of Medicare service use and beneficiary experiences with care.

OBJECTIVE: Examine associations between patient experiences with care and service use across markets. DATA SOURCES/STUDY
SETTING: Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index. STUDY
DESIGN: We estimated correlations and linear regressions of eight measures of case-mix-adjusted beneficiary experiences with intensity of service use across markets. DATA COLLECTION/EXTRACTION: We merged CAHPS data with service use data, excluding beneficiaries under 65 years of age or receiving Medicaid. PRINCIPAL
FINDINGS: Overall, higher intensity use was associated (p<.05) with worse (seven measures) or no better care experiences (two measures). In higher-intensity markets, Medicare FFS and MA beneficiaries reported more problems getting care quickly and less helpful office staff. However, Medicare FFS beneficiaries in higher-intensity markets reported higher overall ratings of their personal physician and main specialist. Medicare MA beneficiaries in higher-intensity markets also reported worse quality of communication with physicians, ability to get needed care, and overall ratings of care.
CONCLUSIONS: Medicare beneficiaries in markets characterized by high service use did not report better experiences with care. This trend was strongest for those in managed care.