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Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration

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Abstract

Background

Comparing health outcomes with adequate methodology is central to performance assessments of health care systems. We compared the Medicare Advantage Program (MAP) and the Veterans Health Administration (VHA) with regard to changes in health status and mortality.

Methods

We used the Death-Master-File for vital status and the Short-Form 36 to determine physical (PCS) and mental (MCS) health at baseline and at 2 years. We compared the probability of being alive with the same or better (than would be expected by chance) PCS (or MCS) at 2 years and mortality, while adjusting for case-mix. Given the geographic variations in MAP enrollment, we did a regional sub-analysis.

Results

There were no significant differences in the probability of being alive with the same or better PCS except for the South (VHA 65.8% vs. MAP 62.5%, P = .0014). VHA patients had a slightly higher probability than MAP patients of being alive with the same or better MCS (71.8% vs. 70.1%, P = .002) but no significant regional variations. The hazard ratios for mortality in the MAP were higher than in the VHA across all regions.

Conclusion

With the use of appropriate methodology, we found small differences in 2-year health outcomes that favor the VHA.

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Acknowledgments

The research in this article was supported by the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) under Contract Numbers 500-00-0055 with NCQA, Office of Quality and Performance (OQP) of the Department of Veterans Affairs, The Center for Health Quality, Outcomes and Economic Research (CHQOER), Department of Veterans Affairs and Boston University School of Public Health. The views expressed in this article are those of the authors and do not necessarily reflect the views of the US Department of Health and Human Services, Centers for Medicare & Medicaid Services, or the National Committee for Quality Assurance, The Department of Veterans Affairs or Boston University. We are indebted to Drs. Samuel C (Chris) Haffer and Steven M. Wright for careful review of the manuscript.

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Authors and Affiliations

  1. Center for Health Quality, Outcomes, and Economic Research, A Health Services Research and Development Field Program, VA Medical Center, Bedford, MA, USA

    Alfredo J. Selim, Lewis E. Kazis, William Rogers, Shirley X. Qian, James A. Rothendler, Avron Spiro III, Xinhua S. Ren, Donald Miller & Benjamin G. Fincke

  2. Boston University School of Medicine, Boston, MA, USA

    Alfredo J. Selim, Bernardo J. Selim & Benjamin G. Fincke

  3. Boston University School of Public Health, Boston, MA, USA

    Lewis E. Kazis, James A. Rothendler, Avron Spiro III, Donald Miller & Benjamin G. Fincke

  4. Health Institute, New England Medical Center, Boston, MA, USA

    William Rogers

  5. Center for the Assessment of Pharmaceutical Practices (formerly called the Health Outcomes Technologies Program), Health Services Department, Boston University School of Public Health, Boston, MA, USA

    James A. Rothendler, Xinhua S. Ren, Donald Miller & Benjamin G. Fincke

  6. Normative Aging Study, MAVERIC, VA Boston Healthcare System, Boston, MA, USA

    Avron Spiro III

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  1. Alfredo J. Selim
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  2. Lewis E. Kazis
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  3. William Rogers
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  4. Shirley X. Qian
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  7. Xinhua S. Ren
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  8. Donald Miller
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  9. Bernardo J. Selim
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  10. Benjamin G. Fincke
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Corresponding author

Correspondence to Alfredo J. Selim.

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SF-36® is a registered trademark of the Medical Outcomes Trust

Appendix

Appendix

Appendix A Comparisons of baseline patient characteristics between MAP enrollees and disenrollees* during the study period
Full size table
 Appendix B Comparisons of baseline patient characteristics between respondents and non-respondents at 2 years in the Medicare Advantage Program and Veterans Health Administration
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Appendix C Comparisons of baseline patient characteristics between respondents with complete and those with incomplete surveys at 2 years in the Medicare Advantage Program and Veterans Health Administration
Full size table

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Selim, A.J., Kazis, L.E., Rogers, W. et al. Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration. Qual Life Res 16, 1179–1191 (2007). https://doi.org/10.1007/s11136-007-9216-2

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