VOL. 23, NO. 23	MAY 20, 1998

hile most elderly Medicare beneficiaries choose traditional fee-for-service (FFS) plans, health maintenance organizations (HMOs), for a variety of reasons, may be a better option.

  In his recent testimony before a commission studying ways to prevent Medicare from going bankrupt, Federal Reserve Chairman Alan Greenspan observed that HMOs and other types of managed care had had “extraordinary success” in taming medical inflation and noted that Medicare “has not kept pace with changes in the private health care system.” HMOs are more efficient in delivering services as well as reducing costs if it is true that the elderly are a sub-population that overutilizes health services.

  A study by doctoral student Ji Seon Lee of Columbia’s School of Social Work suggests that elderly Medicare beneficiaries might be as satisfied, and in some cases, more satisfied with the level and cost of care provided by HMOs. However, as HMOs focus on preventive care, the system needs to be strengthened to better serve those elderly who are chronically ill.

• Lee’s analysis of the most recent Medicare Current Beneficiary Survey revealed differences in how HMO and FFS members use their health service:

• While there was no difference between HMO and FFS users in how satisfied they were with their medical care, HMO users were more satisfied with the cost of their care.

• Elderly with functional limitations enrolled in HMOs are significantly more satisfied with the cost of medical care, but those who use FFS plans are more satisfied with the quality of care and follow-up.

• How satisfied elderly patients are with their health care is the most significant predictor of their health care use: the more satisfied they are with the quality of care and follow-up, the less likely they will return to a health care provider.

• Slightly more HMO-plan members visit their physician than FFS members. However, FFS members visit a specialist more often than HMO plan members. Visits to outpatient departments did not differ.

• HMO plan members are less functionally impaired than FFS members, which implies that a “self-selection” process is involved when members choose a plan: those anticipating a need for extensive/costly care turn away from HMOs and to traditional Medicare.

  One way to ease this burden of supplementary care would be for HMOs to assign care managers with expertise in gerontological care to coordinate an elderly patient’s needs as they arise. Social workers can play an important role in helping the elderly receive necessary health care, by screening and identifying potential health and mental health risks, providing a social support network, and advocating for elderly patients. With the impending “malling of Medicare,” educating the elderly about the various plans’ services and restrictions will become vital, as education has proved to be a significant predictor of health care service use, even more significant than economic factors.