Senior Citizens Like Medicare More Than Younger
People Like Private Health Insurance
Medicare's strong consumer satisfaction suggests
that many under age 65 would choose a public health insurance option if
it were offered, says Commonwealth Fund
May 12, 2009 – Senior citizen Medicare
beneficiaries – those who have reached age 65 - are more satisfied with
their health care, and experience fewer problems accessing and paying
for care, than Americans with employer-sponsored insurance (ESI),
according to a study by Commonwealth Fund researchers published today on
the Health Affairs Website.
The gap between consumers' ratings of Medicare and
ESI has widened since a similar survey in 2001. This study was based on
data gathered in 2007. In both studies, the Medicare beneficiaries over
age 64 were considered separately from younger Americans receiving
Medicare due to disability.
"Right now, policymakers are debating whether to
offer a public health insurance plan to those under 65 as part of
comprehensive health reform. Our results show that, in important ways,
Medicare serves the elderly more effectively than employer-sponsored
coverage serves its enrollees. If given the opportunity, many adults
under age 65 would likely select a public health insurance option," said
lead author Karen Davis, president of the Commonwealth Fund.
The favorable ratings given Medicare by
beneficiaries suggest that they are fundamentally more satisfied with
their coverage relative to those with ESI, say Davis and coauthors
Stuart Guterman, Michelle Doty, and Kristof Stremikis.
Thirty-seven percent of elderly Medicare
beneficiaries rated their coverage as excellent, versus 20 percent of
the employer group.
Meanwhile, only 8 percent of elderly Medicare
beneficiaries rated their insurance as "fair" or "poor," compared with
18 percent of those with ESI.
Survey results demonstrate that Medicare
beneficiaries are less likely than those with private coverage to report
negative experiences with their insurance plans -- including having
expensive medical bills for noncovered services, being charged a lot
more than insurance would pay, and physicians' not taking their
insurance.
For example, only 10 percent of elderly Medicare
beneficiaries said their physician didn't take their insurance, versus
17 percent of those with ESI and 24 percent of those with individual
coverage.
This finding suggests that "Medicare's greater
purchasing power facilitates choice of physicians and access to care,
despite lower provider payment rates," Stuart Guterman, assistant vice
president and director of the Commonwealth Fund's Medicare program,
pointed out.
Other study highlights include:
● Access to care. In spite of having poorer
health and lower incomes than those with ESI, elderly Medicare
beneficiaries were less likely (20 percent versus 37 percent) to report
access problems due to cost, such as not filling a prescription or not
visiting a doctor for a medical problem.
● Financial pressure. Despite their lower
incomes, elderly Medicare beneficiaries reported fewer problems with
medical bills, such as inability to pay or being contacted by collection
agencies. Fifteen percent of them reported at least one of these
problems, compared to 26 percent of those in the employer-coverage
group. Furthermore, elderly Medicare beneficiaries were no more likely
than those with ESI to be devoting 5-10 percent of their income or more
to health care.
● Quality of care. Sixty-one percent of elderly
Medicare beneficiaries said that they had received excellent or very
good care, compared to just half of those with ESI. Moreover, 57 percent
of elderly Medicare beneficiaries were confident that they could get
high-quality, safe care in the future, versus 46 percent of those in the
employer group.
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| ** Emphasis |
Gap Between Medicare and ESI Ratings Has Widened
Since 2001
Between 2001 and 2007, reports of access and
medical-bill problems increased for all adults, whether covered by ESI
or Medicare. However, the gaps on these measures between elderly
Medicare beneficiaries and adults with ESI widened during this period,
after adjusting for poverty, health status, and prescription drug
coverage.
"These findings may reflect some important trends
between 2001 and 2007, which was a period of rapid increases in health
care costs and health insurance premiums. The proportion of firms
offering health benefits declined, and employees' deductibles and cost
sharing under employer-based coverage increased," the Commonwealth
researchers observe.
They also note that Medicare changed significantly
over this period: A prescription drug benefit was added in 2003, and the
proportion of beneficiaries enrolled in private Medicare Advantage plans
-- which were able to use higher payment rates to offer improved
benefits -- increased from 14 percent in 2001 to 18 percent in 2007.
The study is based on data from the Commonwealth
Fund 2007 Biennial Health Insurance Survey, a nationally representative
survey conducted between June 4 and October 24, 2007. The analysis
sample of 3,456 adults (2,616 ages 19-64 and 840 age 65 and older)
excluded forty-five respondents who did not provide an age.
The study categorized adults as follows: elderly
Medicare beneficiary (age sixty-five and older), nonelderly adult (ages
19-64) with employer-based or individual coverage, Medicaid recipient,
disabled Medicare recipient, or uninsured.
>>
The complete report can be accessed by clicking here.
About The Commonwealth Fund
The Commonwealth Fund is a private foundation supporting independent
research on health policy reform and a high performance health system.
About Health Affairs
Health Affairs, published by Project HOPE, is the leading journal of
health policy. The peer-reviewed journal appears bimonthly in print,
with additional online-only papers published weekly as Health Affairs
Web Exclusives at
www.healthaffairs.org.
