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Newsletter Article


Looking at Medicare's Performance

Since 1965, Medicare has helped ensure that America's elderly and disabled have affordable access to a range of health care services. In fact, studies show that Medicare patients are more satisfied with their care than privately insured adults. But can Medicare do more for its beneficiaries? According to The Commonwealth Fund's latest chartbook, Quality of Health Care for Medicare Beneficiaries, the program—like the rest of the U.S. health care system—needs to step up efforts to address gaps in quality and access. The Fund's chartbook is the first publication of its kind to provide a comprehensive portrait of Medicare's performance on multiple measures of quality, including effectiveness, patient safety, access and timeliness, and capacity to improve. In a set of 60 charts, researchers Sheila Leatherman and Douglas McCarthy illustrate Medicare's successes and shortcomings. Among their positive findings:
  • Medicare has achieved its major purpose of providing the elderly and disabled with access to needed care. Once previously uninsured adults become eligible for Medicare, their use of recommended preventive services increases substantially.
  • Only 2.5 percent of elderly adults report not getting needed care, in contrast with 6.1 percent of adults ages 45 to 64.
  • The proportion of women at least 65 years of age who get mammograms has tripled over the past decade.
  • Between 1996 and 2000, the proportion of seniors receiving inappropriate medications declined 37 percent.
  • Although Medicare has achieved great success in ensuring access to needed care and improving the provision of preventive services, large gaps in quality remain, say Leatherman and McCarthy. The researchers cite deficiencies in screening for colorectal cancer, treatment for depression, and control of high blood pressure and high cholesterol. Potentially preventable hospitalizations, moreover, have increased for certain conditions, as have reported rates of adverse events or complications of care in the hospital. The chartbook also highlights disparities in quality for certain populations. For example, minority elderly patients are more likely than white elderly patients to suffer certain potentially preventable adverse events or complications of care, or to receive substandard care. And black patients are less likely than white patients to receive recommended chronic care services, such as blood tests to check on control of diabetes. "Medicare is a national program that should guarantee high standards of care throughout the country, but right now the quality of American health care is too variable and uneven," says Leatherman, a research professor at the University of North Carolina's School of Public Health. "Although the federal government's current Medicare quality efforts represent a promising start, they need to be intensified and accelerated to improve care not only for Medicare beneficiaries but for all Americans."

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