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Medicare Beneficiaries & HMO’s: A Case Study of the Portland, OR Market
Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation’s internal library that could be xeroxed. Please email order@kff.org if you would like to pursue this option
HIV Prevention for Injection Drug Users, Special Supplement to JAIDS
This special supplement from the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology represents a compilation of selected presentations from the 1995 workshop sponsored by the Kaiser Family Foundation in conjunction with the Centers for Disease Control and Prevention, the Center of Substance Abuse Treatment, and the National Institute on Drug Abuse entitled “Sterile Needles and Syringes for Drug Users Who Continue Injecting”. Other related papers prepared by leading experts inthe field offer important insights into strategies for developing effective HIV intervention programs among injection drug users.
Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation’s internal library that could be xeroxed. Please email order@kff.org if you would like to pursue this option.”
This case study of the evolution of Medicare managed care in Portland, Oregon, is part of a series of four case studies being prepared for the Kaiser Family Foundation to learn more about the factors influencing, and consequences of, the growth of Medicare managed care. Portland was one of the first markets to implement a Medicare managed care program, with the Kaiser Foundation Health Plan beginning its Medicare HMO in 1978 and all four of Portland’s current Medicare risk contractors serving the Medicare population by the late 1980s.
This case study of the evolution of Medicare managed care in Tampa-St. Petersburg, Florida, is one of four in a series being prepared by Mathematica Policy Research, Inc., for the Kaiser Family Foundation to examine the growth and impact of Medicare managed care. The Medicare risk (HMO) program has developed at different rates and with different degrees of success across the country. The four unique market areas selected for the project include two with high Medicare plan payment rates and two with moderate rates. The two with high adjusted average per capita cost rates (AAPCC) are Los Angeles and New York City. The two areas with more moderate AAPCC rates are Portland, Oregon and Tampa-St. Petersburg, Florida. Medicare managed care plans in Tampa-St. Petersburg have developed only recently, and they appear to be growing rapidly and prospering.
Que Es El Medicare Y Como Se Financia? Medicare es un programa de seguro medico nacional que atiende a 39 millones de ancianos y discapacitados. Antes de la existencia del Medicare, menos de la mitad de todos los norteamericanos de edad avanzada contaban con un seguro medico. Hoy en dia, practicamente todos los adultos de 65 anos de edad mayores se encuentran asegurados bajo Medicare. Medicare cubre a 34 millones de beneficiarios ancianos y a 5 millones de discapacitados. La cantidad de beneficiarios del Medicare se ha duplicado desde la concepcion del programa en 1965 y se estima que se volvera a duplicar en las siguientes tres decadas hasta alcanzar una cifra de 72 millones.
Medicare Managed Care (Spanish)
Americans Support Requiring Insurers To Cover Contraceptives, Even If Premiums Rise.
More Women and Men Say Contraceptives Should Be Covered Than Say Viagra
Embargoed for release until: 9:30 AM, ET, Friday, June 19, 1998
For further information contact: Tina Hoff or Matt James
Menlo Park, CA – Most Americans support requiring insurers to provide contraceptives as part of prescription coverage, even if premiums rise, according to a new national survey by the Kaiser Family Foundation. The public is also more likely to say contraceptives should be covered by insurers (75%) than Viagra, the new male impotence drug (49%).
Most Americans (62%) are not aware of proposals to require contraceptive coverage now before Congress. After learning that a “bill before Congress would require any health insurance plan with prescription coverage to pay for birth control methods just like any other prescription,” three quarters of Americans say they favor such a policy (45% “strongly favor” and 30% “somewhat favor” vs. 8% “strongly oppose” and 8% “somewhat oppose”). Both women and men (ages 18 and older) say contraceptives should be covered by insurers, though women (81%) are more likely to support such a policy than men (68%). Most (82%) who favor contraceptive coverage say all prescription methods currently on the market – oral contraceptives, IUDs or intra-uterine devices, Norplant implants, diaphragms, the injectable Depo-Provera, and cervical cap – should be paid for.
Support remains strong when people are told that contraceptive coverage could result in higher premiums. For example, when told that “the average cost individuals pay for health insurance could increase by $1-5 per month:” 43 percent “strongly favor” and 30 percent “somewhat favor,” vs. 12 percent “strongly oppose” and 8 percent “somewhat oppose.” Support drops somewhat, although a majority continues to favor contraceptive coverage, if premiums were to rise by larger amounts. For example, when asked their reaction if premiums were to rise by as much as $20 more per month: 30 percent “strongly favor” and 29 percent “somewhat favor,” vs. 19 percent “strongly oppose” and 13 percent “somewhat oppose.”
“Both men and women think comprehensive coverage for contraception makes sense; they think it should be part of prescription coverage, and they say they are willing to pay for it,” said Felicia H. Stewart, MD, Director of Reproductive Health Programs, Kaiser Family Foundation.
Americans More Mixed on Whether Viagra Should be Covered by Insurance
The new drug, Viagra, which sparked a recent debate over insurance coverage when it came on to the market earlier this Spring, draws more mixed views from Americans: 49 percent say the male impotence drug should be covered as part of prescription coverage; 40 percent say it should not be covered; and, 11 percent don’t know. Women (51%) are as likely to favor coverage of Viagra as men (47%).
Women of “Reproductive Age” and Privately Insured Supportive of Contraceptive Coverage
Women between the ages of 18-44, so-called “reproductive age,” are most supportive of legislation to require coverage of prescription contraceptives: almost nine out of ten favor such a policy (67% “strongly support” and 21% “somewhat support” vs. 4% “strongly oppose” and 5% “somewhat oppose”). There is no drop in support if the additional cost for providing this coverage falls in the low range ($1-5 per month) for an individual premium (87% support vs. 11% oppose); even at the higher range ($15-20 per month): 74 percent support (22% oppose). Women in this age range also are the most likely to say all methods should be covered (83%).
Three quarters of these women, who are most likely to use prescription contraceptives, say whether or not a certain method is covered by their insurance is something they would factor into their decision about what to use: 40 percent say coverage is “very” important, and 34 percent say “somewhat” in choosing birth control.
Family planning services, including contraceptives, are a required benefit under Medicaid, the public program that provides health coverage for low-income Americans. The contraceptive coverage proposal now before Congress applies to the privately insured population. Among this group, which would most directly benefit from the expanded coverage as well as potentially bear some of the additional costs if their insurer does not currently provide a full-range of contraceptive options, most support the policy. Eight out of ten privately-insured Americans, excluding those eligible for Medicare (65 and older), support contraceptive coverage (47% “strongly support” and 33% “somewhat support ” vs. 7% “strongly oppose” and 8% “somewhat oppose”). Even if their premiums were to go up, this group says they would still favor it ($1-5 per month: 78% support vs. 18% oppose; $15-20 per month: 64% support vs. 31% oppose). Women of reproductive age and the privately insured are no more likely than the average American to know that legislation has been proposed.
Methodology
The Kaiser Family Foundation 1998 National Survey on Insurance Coverage of Contraceptives is a random-sample telephone survey of 1,015 adults 18 and older living in the United States. It was designed by staff at the Foundation and Princeton Survey Research Associates (PSRA) and conducted by PSRA between May 22-26, 1998. The margin of sampling error is plus or minus 3 percent for the national sample; it may be higher for smaller sub-groups.
The Kaiser Family Foundation, based in Menlo Park, California, is an independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.
The questionnaire and top line from the survey are available by calling the Kaiser Family Foundation’s publication request line at 1-800-656-4533 (Ask for documents #1404). This release is also available on the Kaiser Family Foundation website at www.kff.org
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Press Release (.pdf)
Topline/Survey (.pdf)
Three reports examining how health issues are handled by the Latino-oriented media today and how Latinos use the media as an information source on health issues. The three new studies were released at the National Association of Hispanic Journalists (NAHJ) conference. The studies are also available separately: A National and Three Region Survey of Latinos on the Media and Health, conducted by Princeton Survey Research Associates (#1410), A Study of Health Coverage in Latino Newspapers, Television and Radio News, 1997-1998 (#1411), A Study of Sexual Health Coverage in Latino Magazines, 1997-1998 (#1412), Summary of the three reports (#1413).
This report assesses the potential impact of selected recommendations of the Managed Health Care Improvement Task Force in the areas of access to care and specialists, information disclosure, and dispute resolution. The Managed Health Care Improvement Task Force was established in 1998 to inform state leaders about the health industry in California; the impact of managed care on quality, access, and cost of care; issues of special concern to consumers; and the appropriate role of government in relation to managed care.