Managed Health Care, Elderly Access and Satisfaction

最近实施的联邦医疗保险计划的重大变化，特别是引入和计划扩大联邦医疗保险-选择(M+C)计划或C部分选项，可能会对老年医疗保健消费者产生重大影响。这项试点研究资助申请涉及2000年2月2日NIA试点研究资助计划说明中的主题#23(老年人护理)中包含的“老年人护理的组织和提供如何影响与健康相关的行为和结果”的主题。这项拟议的试点研究的目标是：探索可用于描述当地市场中出现的管理型医疗安排的基本情况的替代方法，研究用于描述和评估当地市场中管理型医疗组织(MCOS)发展阶段的方法；了解BBA 97可能对Medicare受益人构成的主要问题；以及开发适当的概念框架和适当的研究工具，以更好地了解BBA 97对老年客户的微观影响。该项目的五个具体目标和方法是：(1)进行全面的文献审查，重点是已发表和未发表的报告，试图描述管理型医疗安排的主要要素、不断变化的MCO类型以及如何随着时间的推移最好地了解当地市场的发展；(2)开展由社区老年人组成的焦点小组，以更好地了解客户对医疗保险受益人所需的健康计划选择类型的当前理解水平，以及消费者选择的潜在影响；(3)研究用于了解医生与老年客户互动的动态以及这种活动模式对客户服务获得和满意度的影响的概念框架；(4)评估可用于了解医生与老年客户互动的动态和结果并根据需要准备新措施的现有方法和工具；及(5)起草一份报告，总结研究的文献综述结果、消费者焦点小组的结果以及在快速变化的保健环境中理解医生与老年客户互动的动态和结果的方法。

Recently implemented major changes in the Medicare program, especially the introduction and projected expansion of Medicare-Choice (M+C) plans or the Part C option, potentially have significant implications for older health care consumers. This pilot study grant application addresses the topic of "how the organization and delivery of care for older people influence health-related behaviors and outcomes" contained within topic #23 (Care for Older People) in the NIA Pilot Research Grant Program description dated February 2,2000. The goals of this proposed pilot study are to: explore alternative methods that can be used to describe the basic of managed care arrangements that arise within a local market, examine approaches that are used to describe and assess developmental stages of managed care organization (MCOs) within local market; understand the major issues that BBA 97 will likely pose to Medicare beneficiaries; and to develop a suitable conceptual framework and appropriate research instruments to gain a better understanding of the micro-level impacts of BBA 97 on elderly clients. The five specific aims and methods of the project are to: (1) Conduct a comprehensive literature review focused on published and unpublished reports of attempts to characterize the major elements of managed care arrangements, changing types of MCOs and how the development of local markets can best be understood over time; (2) Perform focus groups comprised of older persons in the community in order to understand better the current levels of client understanding of the types of health plan choices that will be required of Medicare beneficiaries and the potential impacts of consumer choices; (3) Examine conceptual frameworks that are used to understand the dynamics of doctor-elderly client interaction and the effects of such patterns of activity upon client service access and satisfaction; (4) Assess current methodological approaches and instruments that can be used to understand the dynamics and outcomes of doctor-elderly client interaction and to prepare new measures as needed; and (5) Draft a report that will summarize the study's findings of the literature review, results of the consumer focus groups and approaches to understanding the dynamics and outcomes of doctor-older client interaction amidst a rapidly changing health care environment.