Older Medicare enrolees' choices for insured services.

OBJECTIVES

The Medicare Trust Fund is expected to be bankrupt in the next decade, thus threatening the viability of the Medicare Program. We have ascertained what Medicare enrollees' priorities for insured services would be, and why, if it were fiscally necessary to limit Medicare benefits to maintain the viability of the Program.

DESIGN

A cross-sectional survey using anonymous, inperson interviews and an innovative instrument to elicit choices.

SETTING

General Internal Medicine outpatient clinic at a university teaching hospital.

PARTICIPANTS

One hundred five adults, 65 years of age and older, who had primary care physician visits between July and September 1995.

MEASUREMENTS

Desire to personally select insurance benefits, insurance benefit choices, and the reasons for selection or rejection of benefits.

RESULTS

Subjects of various educational and economic backgrounds were able to carry out the selection process with relative case, and four-fifths of respondents preferred to make their own choices about insured services. The most frequently selected services were hospitalization, outpatient care, prescription drugs, eye care, and home care, in descending order. Subjects selected 52 different combinations of services. Only 2% of respondents picked the current Medicare service package. The reasons given for selection varied by service; cost and current or anticipated need for a service were the most frequently cited forces driving the choices made.

CONCLUSION

These data suggest that Medicare enrollees prefer some element of choice about their health insurance coverage. Their choices vary widely and differ from the current Medicare package.