Managed Health Care, Elderly Access and Satisfaction

最近在医疗保险计划中实施的重大变化，特别是医疗保险选择（M+C）计划或C部分选项的引入和预计扩展，可能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试点研究资助计划描述中主题#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健康相关行为和结果”的主题。 这项试验性研究的目的是：探索可用于描述当地市场中出现的管理式医疗安排的基本情况的替代方法，检查用于描述和评估当地市场中管理式医疗组织（MCOs）发展阶段的方法;了解BBA 97可能对医疗保险受益人造成的主要问题;以及发展适当的概念架构和研究工具，以便更深入了解商管局九七对长者服务对象的微观影响。 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，这些报告试图描述管理式护理安排的主要要素、不断变化的医务组织类型以及如何最好地了解当地市场的发展;（二）开展由社区老年人组成的焦点小组活动，以更好地了解客户对Medicare受益人所需的健康计划选择类型的当前理解水平，消费者选择的潜在影响;（3）检查用于了解医生与老年客户互动的动态以及此类活动模式对客户服务获得和满意度的影响的概念框架;（4）评估当前可用于了解医生与老年客户互动的动态和结果的方法和工具，并根据需要制定新的措施;及（5）草拟一份报告，总结研究的文献回顾结果、消费者焦点小组的结果，以及在快速变化的医疗环境中了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specific aims and methods of the project are to: (1) Conduct a comprehensive literature review focused on published and unpublished reports of attempts to characterize the major elements of managed care arrangements, changing types of MCOs and how the development of local markets can best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.