tci Medicare Compliance & Reimbursement - 2004 Issue 4

Medicare+Choice: SENIORS IN FOR-PROFIT PLANS NOT DENIED HIGH-COST CARE

At least in the Medicare program, for-profit managed care plans provide as much access to expensive medical care as their nonprofit counterparts. So says a study in the Jan. 8 New England Journal of Medicine, which looked at the experiences of more than 3.7 million seniors enrolled in Medicare managed care plans during 1997. Roughly two-thirds of the seniors were distributed among 166 for-profit plans, while the remaining third were in 88 nonprofit plans. Seniors enrolled in for-profit plans received each of 12 common high-cost surgical procedures at least as often as seniors in nonprofits, and for-profit enrollees...

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