Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration
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Comparing health outcomes with adequate methodology is central to performance assessments of health care systems. We compared the Medicare Advantage Program (MAP) and the Veterans Health Administration (VHA) with regard to changes in health status and mortality.
We used the Death-Master-File for vital status and the Short-Form 36 to determine physical (PCS) and mental (MCS) health at baseline and at 2 years. We compared the probability of being alive with the same or better (than would be expected by chance) PCS (or MCS) at 2 years and mortality, while adjusting for case-mix. Given the geographic variations in MAP enrollment, we did a regional sub-analysis.
There were no significant differences in the probability of being alive with the same or better PCS except for the South (VHA 65.8% vs. MAP 62.5%, P = .0014). VHA patients had a slightly higher probability than MAP patients of being alive with the same or better MCS (71.8% vs. 70.1%, P = .002) but no significant regional variations. The hazard ratios for mortality in the MAP were higher than in the VHA across all regions.
With the use of appropriate methodology, we found small differences in 2-year health outcomes that favor the VHA.
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- Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration
Quality of Life Research
Volume 16, Issue 7 , pp 1179-1191
- Cover Date
- Print ISSN
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- Springer Netherlands
- Additional Links
- Health status
- Health care system comparison
- Industry Sectors
- Author Affiliations
- 1. Center for Health Quality, Outcomes, and Economic Research, A Health Services Research and Development Field Program, VA Medical Center, Bedford, MA, USA
- 2. Boston University School of Medicine, Boston, MA, USA
- 3. Boston University School of Public Health, Boston, MA, USA
- 4. Health Institute, New England Medical Center, Boston, MA, USA
- 5. Center for the Assessment of Pharmaceutical Practices (formerly called the Health Outcomes Technologies Program), Health Services Department, Boston University School of Public Health, Boston, MA, USA
- 6. Normative Aging Study, MAVERIC, VA Boston Healthcare System, Boston, MA, USA