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医疗保险管理式医疗:消费者视角

Medicare managed care: consumers' perspectives.

作者信息

Wilson J

机构信息

CareData Reports, Inc., White Plains, New York, USA.

出版信息

Clin Ther. 1998 Nov-Dec;20(6):1263-76. doi: 10.1016/s0149-2918(98)80121-5.

DOI:10.1016/s0149-2918(98)80121-5
PMID:9916618
Abstract

The 1997 CareData survey of members of Medicare risk health maintenance organizations (HMOs) measured the degree of satisfaction of Medicare managed care members with emphasis on pharmacy-related issues and specific disease treatment perceptions. The survey was a 12-page, self-administered questionnaire assessing more than 150 issues; it was distributed to 23,140 known enrollees of Medicare risk HMOs by their former employers between May and July 1997. A total of 12,265 Medicare beneficiaries enrolled in more than 70 major health plans in 23 US geographic markets completed and returned their questionnaires (response rate, 53%). The pharmacy benefit was cited by 75% of the respondents as the reason for joining their plan; 81% of the respondents reported being highly satisfied with the pharmacy benefit overall, with regional variations from a low of 60% to a high of 82%. The issues driving enrollees' satisfaction after being in their plan for a minimum of 6 months and a mean length of slightly more than 3 years were: satisfaction with customer service and plan administration (11.6% explained variance); the plan's concern for the member's well-being (10.6%); the belief that the care improved the member's health and well-being (9.2%); satisfaction with choice of specialists (5.3%); satisfaction with the pharmacy plan (5.1%); and satisfaction with the primary care physician (4.8%). Significant variations were seen among regions, plans, and the self-reported health status of the respondents.

摘要

1997年对医疗保险风险健康维护组织(HMOs)成员进行的CareData调查,衡量了医疗保险管理式医疗成员的满意度,重点是与药房相关的问题以及对特定疾病治疗的看法。该调查是一份12页的自填式问卷,评估了150多个问题;1997年5月至7月间,其前雇主将问卷分发给了23140名已知的医疗保险风险HMOs参保人。共有12265名医疗保险受益人参与了美国23个地理区域市场的70多个主要健康计划,他们填写并返还了问卷(回复率为53%)。75%的受访者表示,药房福利是他们加入该计划的原因;81%的受访者表示总体上对药房福利非常满意,各地区满意度有所不同,最低为60%,最高为82%。在参保至少6个月且平均参保时长略超过3年之后,影响参保人满意度的因素包括:对客户服务和计划管理的满意度(解释方差为11.6%);计划对成员福祉的关注(10.6%);认为护理改善了成员的健康和福祉(9.2%);对专科医生选择的满意度(5.3%);对药房计划的满意度(5.1%);以及对初级保健医生的满意度(4.8%)。不同地区、计划以及受访者自我报告的健康状况之间存在显著差异。

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