As the Public Policy Institute Report for AARP has shown, it is still unclear what savings the organizations have provided and if there is any actual benefit from this program. Nevertheless, it stresses that care management is promising when its activities are highly focused, i.e. the target population with specific conditions and requirements. The Social Health Maintenance Organizations are able to provide benefits to those citizens they are focusing on. For example, HMOs have a slower cost growth compared to Preferred Provider Organization (PPOs) and therefore citizens with a limited income will most likely shift to HMOs if they have been using PPOs before (Ho, Pakes, & Shepard, 2016). Although the general benefits from HMOs are not present in Medicaid and Medicare reports, they provide serious support to the elderly with low income; after some provider organizations had shifted to global payments, the HMOs cost growth slowed down again and attracted more customers with lower income or financial instability (Ho et al., 2016). According to one study, the subjective perception of the health status was better when elderly patients were under Medicare HMO (Yamada et al., 2015). Therefore, services provided by HMO also reduced the negative perception of the elderly compared to the standard fee-for-service health insurance.
As it was stated in several studies, the Medicare and Medicaid programs’ benefits are still too rarely examined to provide specific data about the case. Moreover, the results can often be contradictory: while some of the studies point out that the HMOs are able to reduce the cost of healthcare for the beneficiaries, Bhattacharjee et al. (2015) notice that patients with Parkinson disease who were also Medicare beneficiaries have had higher expenditures compared to citizens with PD who were not beneficiaries of the Medicare program. Therefore, it remains unclear whether HMOs are actually able to bring benefits or not.
References
Bhattacharjee, S., Metzger, A., Tworek, C., Wei, W., Pan, X., & Sambamoorthi, U. (2015). Parkinson’s disease and home healthcare use and expenditures among elderly Medicare beneficiaries. Parkinson’s Disease, 1(1), 1-11.
Ho, K., Pakes, A., & Shepard, M. (2016). The evolution of health insurer costs in Massachusetts, 2010-12 (NBER Publication No. w22835). Washington, DC: U.S. Government Printing Office.
Yamada, T., Chen, C. C., Murata, C., Hirai, H., Ojima, T., & Kondo, K. (2015). Access disparity and health inequality of the elderly: Unmet needs and delayed healthcare. International Journal of Environmental Research and Public Health, 12(2), 1745-1772.