By 2030, 1 in 5 Americans (73.1 million) will be at or above 65 years old, thus eligible for the country’s chief health insurance program, Medicare. This demographic shift has been a decades-long rallying cry of gerontologists, with experts arguing that the health care system needs to prepare for an aging population currently serving more than 50 million older Medicare beneficiaries. In a health care system fraught with burden, shortages, and burnout, recent research shows the semi-private insurance option, Medicare Advantage (MA), may lead to better outcomes for older adults.
Medicare beneficiaries are offered the option to enroll in the Advantage program which is managed by private insurance companies (think: Aetna, Humana). Approximately 26 million beneficiaries choose to enroll in these programs, indicating their popularity and accessibility has grown in recent years. MA plans offer streamlined insurance provisions by bundling Parts A, B and D coverage through network-affiliated providers unlike traditional Medicare which beneficiaries can use anywhere Medicare is accepted. Critics of MA note that this difference creates narrower networks, thereby, reducing the number of available doctors and, like any health insurance company, overlooks individual beneficiary needs.
Dr. Sungchul Park, Department of Health Policy and Management at Korea University, recently published two articles assessing Medicare Advantage’s effect on health outcomes of older patients in HSR, an official journal of AcademyHealth. Park and colleagues found MA enrollment has led to a reduction of hospital deaths, increased hospice use and better care for beneficiaries with mental health issues that appears to reflect beneficiaries’ wants and needs. Some MA critics note that MA enrollment outcomes are skewed by MA plans enrolling healthier beneficiaries, but Park and colleagues addressed this concern in their studies by employing econometric methods.
Most older adults prefer to have a say in where they die, typically choosing a calm, intimate setting outside of hospitals. Park and colleagues found MA enrollment increases hospice use for those recently admitted to the hospital at end-of-life, thus lowering hospital deaths. The study found hospice use increased by nearly 20 percent compared to traditional Medicare. This means that those who prefer to die outside of the hospital were able to do so under MA diversion opportunities. The authors note that these services were mostly offered within the last week of a beneficiaries’ life indicating an area for improvement and further research.
In another related study, Park solely studied the effect of MA enrollment on health care use among those with mental health issues. Typically, health care use for those with mental health issues is high, and costs are significant under traditional Medicare, but Park found MA enrollees with mental health issues had lower utilization suggesting efficiency of care. Other researchers have expressed concerns that MA enrollment affects access to care as more beneficiaries are forced to use out-of-network providers. In fact, only 18 percent of mental health providers accept MA. This study found that those with mental health care issues did not experience delays or challenges with access. However, 25 percent of beneficiaries expressed dissatisfaction with out-of-pocket costs suggesting that individuals navigate outside the narrow networks, thereby affecting enrollees’ livelihood.
By privatizing a public health insurance program, MA has been a learning experience. The work done by Park and colleagues, as well as other health service researchers, assesses the current public health insurance infrastructure with implications for a growing population. These studies move the field forward in our understanding of how public-private partnerships may enhance health outcomes for older patients and for those who are aging into the demographic shift.
For more information on this study, please contact Dr. Sungchul Park, Department of Health Policy and Management at Korea University.
As part of our mission to advance evidence to inform policy and practice, AcademyHealth works with HSR, one of our official journals, to develop and publish plain language summaries of selected articles from each issue. Articles are selected by HSR Editor-in-Chief Austin Frakt, Ph.D., and the summaries are prepared by AcademyHealth staff in partnership with article authors.