Quality of Life Research

, Volume 16, Issue 7, pp 1179–1191

Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration

  • Alfredo J. Selim
  • Lewis E. Kazis
  • William Rogers
  • Shirley X. Qian
  • James A. Rothendler
  • Avron SpiroIII
  • Xinhua S. Ren
  • Donald Miller
  • Bernardo J. Selim
  • Benjamin G. Fincke
Original Paper

DOI: 10.1007/s11136-007-9216-2

Cite this article as:
Selim, A.J., Kazis, L.E., Rogers, W. et al. Qual Life Res (2007) 16: 1179. doi:10.1007/s11136-007-9216-2

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

With the use of appropriate methodology, we found small differences in 2-year health outcomes that favor the VHA.

Keywords

Health status Mortality Outcomes Elderly Health care system comparison 

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Alfredo J. Selim
    • 1
    • 2
  • Lewis E. Kazis
    • 1
    • 3
  • William Rogers
    • 1
    • 4
  • Shirley X. Qian
    • 1
  • James A. Rothendler
    • 1
    • 3
    • 5
  • Avron SpiroIII
    • 1
    • 3
    • 6
  • Xinhua S. Ren
    • 1
    • 5
  • Donald Miller
    • 1
    • 3
    • 5
  • Bernardo J. Selim
    • 2
  • Benjamin G. Fincke
    • 1
    • 2
    • 3
    • 5
  1. 1.Center for Health Quality, Outcomes, and Economic Research, A Health Services Research and Development Field Program, VA Medical CenterBedfordUSA
  2. 2.Boston University School of MedicineBostonUSA
  3. 3.Boston University School of Public HealthBostonUSA
  4. 4.Health InstituteNew England Medical CenterBostonUSA
  5. 5.Center for the Assessment of Pharmaceutical Practices (formerly called the Health Outcomes Technologies Program), Health Services DepartmentBoston University School of Public HealthBostonUSA
  6. 6.Normative Aging Study, MAVERICVA Boston Healthcare SystemBostonUSA

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