McCormack L A, Anderson W L, Uhrig J D, Garfinkel S A, Sofaer S, Terrell S A
RTI International, Research Triangle Park, NC 27709, USA.
Health Serv Res. 2001 Dec;36(6 Pt 2):133-49.
To examine the effect of providing the Medicare & You handbook on consumers' attitudes and behavior regarding health plan decision making.
A national sample of 3,738 Medicare beneficiaries who were surveyed in late 1999 and early 2000 was employed. Data were collected using a mail survey with telephone follow-up; the response rate was 76 percent.
Medicare beneficiaries were randomly assigned to a control group that received no Medicare-related in formation as part of the study, or to a treatment group that received a copy of the 2000 version of the Medicare & You handbook as part of a national mailing. Half of the treat men t group (the "re-mail" group) received a second copy of the handbook along wit h their mail survey instrument.
The control and treatment groups did not differ regarding their level of satisfaction with or confidence in their current choice of health plan according to predicted mean values. Treatment group beneficiaries had a significantly higher propensity to either change or consider changing health plans relative to beneficiaries in the control group. Controlling for other factors, 5 percent of treatment group members switched health insurance plans during the prior month compared to 3 percent of control group members. there were no significant differences in predicted values between the re-mail and no re-mail groups in any of the models. Type of supplemental insurance was also highly related to all three outcomes.
Findings from this and a prior parallel study suggest th at messages contained in the Medicare & You handbook can have an influence on beneficiaries and the Medicare market . Thus, careful attention should be given to the wording and intent of these messages. This is particularly relevant given the current administration's emphasis on increasing enrollment in Medicare+Choice plans and findings from earlier research reporting that beneficiaries felt the handbook was pressuring them to enroll in managed care.
研究提供《医疗保险与您》手册对消费者在健康计划决策方面的态度和行为的影响。
采用了1999年末和2000年初对3738名医疗保险受益人的全国性抽样调查数据。通过邮寄调查并进行电话随访收集数据；回复率为76%。
医疗保险受益人被随机分配到对照组（作为研究的一部分，未收到任何与医疗保险相关的信息）或治疗组（作为全国性邮寄的一部分，收到2000版《医疗保险与您》手册）。治疗组的一半（“重新邮寄”组）在收到邮寄调查问卷时还收到了手册的第二份副本。
根据预测均值，对照组和治疗组对当前健康计划选择的满意度或信心水平没有差异。与对照组的受益人相比，治疗组的受益人更换或考虑更换健康计划的倾向明显更高。在控制其他因素的情况下，前一个月治疗组中有5%的成员更换了医疗保险计划，而对照组为3%。在任何模型中，重新邮寄组和未重新邮寄组的预测值均无显著差异。补充保险类型也与所有三个结果高度相关。
本研究及之前一项平行研究的结果表明，《医疗保险与您》手册中的信息可能会对受益人及医疗保险市场产生影响。因此，应仔细关注这些信息的措辞和意图。鉴于现任政府强调增加医疗保险+选择计划的参保人数，以及早期研究报告称受益人认为手册在迫使他们加入管理式医疗，这一点尤为重要。
