Skip to main content
PMC home page
Health Services Research logoLink to Health Services Research
. 1988 Dec;23(5):685–720.

Designing health insurance information for the Medicare beneficiary: a policy synthesis.

B N Davidson 1
PMCID: PMC1065532  PMID: 3060450

Abstract

Can Medicare beneficiaries make rational and informed decisions about their coverage under the Medicare program? Recent policy developments in the Medicare program have been based on the theory of competition in medical care. One of the key assumptions of the competitive model is the free flow of adequate information, enabling the consumer to make an informed choice from among the various sellers of a particular product. Options for Medicare beneficiaries in supplementing their basic Medicare coverage include the purchase of private supplementary insurance policies or enrollment in a Medicare HMO. These consumers, in a complex health insurance market, have only limited information available to them because many health plans do not make adequate comparable product information available. Moreover, since the introduction of the Medicare HMO option, the long-range plan for management of the Medicare budget has become based on the large-scale voluntary enrollment of beneficiaries into capitated health plans. The policy instrument that has been used to improve beneficiary decisions on how to supplement Medicare coverage is the informational or educational program. This synthesis presents findings regarding the relative effectiveness of different types of health insurance information programs for the Medicare beneficiary in an effort to promote practical use of the most effective types of information.

Full text

PDF
689

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cafferata G. L. Knowledge of their health insurance coverage by the elderly. Med Care. 1984 Sep;22(9):835–847. doi: 10.1097/00005650-198409000-00008. [DOI] [PubMed] [Google Scholar]
  2. Cohodes D. R. Medicare catastrophic coverage: a program in search of a problem. Inquiry. 1986 Summer;23(2):109–110. [PubMed] [Google Scholar]
  3. Dopkeen J. C. Pew Memorial Trust policy synthesis: 2. Postretirement health benefits. Health Serv Res. 1987 Feb;21(6):795–848. [PMC free article] [PubMed] [Google Scholar]
  4. Feder J., Moon M., Scanlon W. Medicare reform: nibbling at catastrophic costs. Health Aff (Millwood) 1987 Winter;6(4):5–19. doi: 10.1377/hlthaff.6.4.5. [DOI] [PubMed] [Google Scholar]
  5. Ginsburg P. B., Hackbarth G. M. Alternative delivery systems and Medicare. Health Aff (Millwood) 1986 Spring;5(1):6–22. doi: 10.1377/hlthaff.5.1.6. [DOI] [PubMed] [Google Scholar]
  6. Greenfield C. A. Improving elderly access to health care information. Bus Health. 1986 Jun;3(7):26-7, 30. [PubMed] [Google Scholar]
  7. Hagen R. Medigap insurance: pitfalls and progress. Bus Health. 1986 Apr;3(5):25-7, 30. [PubMed] [Google Scholar]
  8. Hibbard J. H., Weeks E. C. Consumerism in health care. Prevalence and predictors. Med Care. 1987 Nov;25(11):1019–1032. doi: 10.1097/00005650-198711000-00001. [DOI] [PubMed] [Google Scholar]
  9. Iglehart J. K. Medicare turns to HMOs. N Engl J Med. 1985 Jan 10;312(2):132–136. doi: 10.1056/NEJM198501103120237. [DOI] [PubMed] [Google Scholar]
  10. Iglehart J. K., White J. K. Catastrophic health insurance: public/private role debated. Health Prog. 1986 Nov;67(9):10-1, 13. [PubMed] [Google Scholar]
  11. Kosterlitz J. HMO "risk contracting" has its risks. Natl J (Wash) 1988 Jan 16;20(3):143–143. [PubMed] [Google Scholar]
  12. LaTour S. A., Friedman B., Hughes E. F. Medicare beneficiary decision making about health insurance. Implications for a voucher system. Med Care. 1986 Jul;24(7):601–614. doi: 10.1097/00005650-198607000-00004. [DOI] [PubMed] [Google Scholar]
  13. Manning W. G., Leibowitz A., Goldberg G. A., Rogers W. H., Newhouse J. P. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. doi: 10.1056/NEJM198406073102305. [DOI] [PubMed] [Google Scholar]
  14. Marquis M. S. Consumers' knowledge about their health insurance coverage. Health Care Financ Rev. 1983 Fall;5(1):65–80. [PMC free article] [PubMed] [Google Scholar]
  15. McCall N., Rice T., Sangl J. Consumer knowledge of Medicare and supplemental health insurance benefits. Health Serv Res. 1986 Feb;20(6 Pt 1):633–657. [PMC free article] [PubMed] [Google Scholar]
  16. McMillan A., Lubitz J., Russell D. Medicare enrollment in health maintenance organizations. Health Care Financ Rev. 1987 Spring;8(3):87–93. [PMC free article] [PubMed] [Google Scholar]
  17. Mott P. D. Hospital utilization by health maintenance organizations. Separating apples from oranges. Med Care. 1986 May;24(5):398–406. doi: 10.1097/00005650-198605000-00003. [DOI] [PubMed] [Google Scholar]
  18. Peres J. R. Elderly care: a case of catastrophic confusion? Bus Health. 1987 Sep;4(11):7–10. [PubMed] [Google Scholar]
  19. Rice T., McCall N. The extent of ownership and the characteristics of Medicare supplemental policies. Inquiry. 1985 Summer;22(2):188–200. [PubMed] [Google Scholar]
  20. Schramm C. J. Why restructuring Medicare will not work. Bus Health. 1987 Sep;4(11):12–13. [PubMed] [Google Scholar]
  21. Smeeding T. M., Straub L. Health care financing among the elderly: who really pays the bills? J Health Polit Policy Law. 1987 Spring;12(1):35–52. doi: 10.1215/03616878-12-1-35. [DOI] [PubMed] [Google Scholar]
  22. Spitz B., Abramson J. Competition, capitation, and case management: barriers to strategic reform. Milbank Q. 1987;65(3):348–370. [PubMed] [Google Scholar]
  23. Tanzer J., Nudelman J. Medicare and HMOs: a marriage of convenience? Bus Health. 1987 Aug;4(10):34–36. [PubMed] [Google Scholar]
  24. Titus S. L. Barriers to the health maintenance organization for the over 65's. Soc Sci Med. 1982;16(20):1767–1774. doi: 10.1016/0277-9536(82)90270-2. [DOI] [PubMed] [Google Scholar]
  25. Varner T., Christy J. Consumer information needs in a competitive health care environment. Health Care Financ Rev. 1986;(Spec No):99–104. [PMC free article] [PubMed] [Google Scholar]
  26. Waldo D. R., Levit K. R., Lazenby H. National health expenditures, 1985. Health Care Financ Rev. 1986 Fall;8(1):1–21. [PMC free article] [PubMed] [Google Scholar]
  27. Wattenberg S. H., McGann L. M. Medicare or 'medigap'? Dilemma for the elderly. Health Soc Work. 1984 Summer;9(3):229–237. doi: 10.1093/hsw/9.3.229. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES