The findings of better satisfaction, access, and security experienced by Medicare beneficiaries mean that would-be Medicare reformers need to be cautious if they want to make the program more like the private sector, according to the Commonwealth Fund's survey.
"Medicare beneficiaries' more positive access experiences and ratings of their care indicate that their coverage is working relatively well in providing choice of services and access to needed care," writes Commonwealth Fund president Karen Davis and her colleagues. "Thus, attempts to reform Medicare that would pattern coverage on private employer coverage run the risk of undermining the confidence of the people it is designed to serve."
The survey, based on interviews with 3,457 Americans age 19 and older in July 2001, also found that elderly Medicare beneficiaries were one-quarter as likely to report problems paying their bills and less than half as likely to say they paid a lot out of pocket for drugs or dental services, according to the Commonwealth Fund's survey.
* 22 percent of the privately insured people found that their plan did not pay for care that they thought was covered, compared to 9 percent of elderly Medicare beneficiaries
* 9 percent of the privately insured people had difficulty getting a referral to a specialist, compared to 2 percent of elderly Medicare beneficiaries
* 33 percent of privately insured people were unable to pay their bills or had been contacted by a collection agency, compared to 18 percent of elderly Medicare beneficiaries
* 12 percent of elderly Medicare beneficiaries said they "had to change way of life" to pay medical bills, compared to 9 percent of privately insured people
* 29 percent of elderly Medicare beneficiaries paid more than 5 percent of their income in out-of-pocket costs, compared to 10 percent of privately insured people
The authors write that the latter two findings indicate the need for prescription drug coverage under Medicare, because beneficiaries without such coverage were more likely to report high out-of-pocket costs. The article can be read at http://www.healthaffairs.org/WebExclusives/Davis_Web_ Excl_100902.htm.
Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research.