Trust is a fundamentally important aspect of medical treatment relationships. Studies have established that patient trust predicts instrumental variables such as use of preventive services, adherence, and continued enrollment at least as well as satisfaction does, and is more salient for measuring the quality of ongoing relationships. Measuring trust would help to inform public policy deliberations and balance market forces that threaten the doctor-patient relationship. Several validated measures could be easily included in surveys. While further studies to evaluate the cost-effectiveness of measuring trust and test interventions to improve trust are desirable, the action merits serious consideration.

No abstract

Enrollment in Medicare Advantage has grown rapidly from 2003 to today. For the years 2003–2009, we compared individual-level Healthcare Effectiveness Data and Information Set (HEDIS®) data collected from all plans on service utilization by patients enrolled in Medicare Advantage HMO plans with comparable claims-based measures for matched samples from traditional Medicare. Controlling for self-reported health, health plan enrollees had lower rates of ambulatory visits and hospitalizations initially that converged by 2008 and fewer emergency department visits and ambulatory procedures (~25–30%). Health plan enrollees received fewer hip or knee replacements (lower by ~10%) but more coronary bypass surgery. Our study suggests utilization of services may be more appropriate in Medicare Advantage.

Among older persons, UI is common, underdiagnosed, and associated with substantial functional impairment. There appears to be considerable opportunity to mitigate the effects of UI on health and quality of life among community-dwelling older persons.

To compare quality of care nationally between Medicare Advantage health maintenance organizations (HMOs) and traditional Medicare and determine how various types of Medicare HMOs differed in quality from traditional Medicare, we assessed performance measures of the quality of ambulatory care from the among beneficiaries matched by demographic characteristics within local areas during 2003-2009. HMO enrollees were consistently more likely than traditional Medicare beneficiaries to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. Personal physicians were rated less highly in HMOs than traditional Medicare in 2003, but more highly in 2009. Not-for-profit, larger, and older HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. The effects on ambulatory quality of care of more integrated delivery systems in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.