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GAO United State8 General Account&Office kw3r3 Washington, D.C. 20648
Haalth,EducationandBumanServicesDivision
B-261414
May 25, 1995
The Honorable John R. Kasich Chairman, Committee on the Budget House of Representatives
Dear Mr. Chairman:
Your office asked us to provide you with information on health maintenance organization (HMO) enrollment. This letter presents data on the number of Medicare beneficiaries enrolled in risk-based HMOs, cost-based HMOs, and fee-for-service plans in 1993 and 1994. Between December 1993 and December 1994, the percentage of Medicare beneficiaries enrolled in risk-based HMOs increased from 5.1 to 6.3 percent. Although older beneficiaries had lower enrollment rates than those of the general Medicare population, they also increasingly joined risk-based HMOs. Between 1993 and 1994, the percentage of Medicare beneficiaries aged 75 and older enrolled in risk-based HMOs increased from 4.8 to 6.1 percent. Similarly, for those beneficiaries aged 85 years and older, the percentage increased from 3.9 to 4.7 percent.
We have enclosed the following tabulations:
-- variable definitions (enclosure 1);
-- variable totals, for example, line 1 indicates that 1,821,247 Medicare beneficiaries were enrolled in a risk-based HMO in 1993 (enclosure 2);
-- breakdown of enrollment data by state (enclosure 3);
-- top 50 counties in total beneficiaries enrolled in 1994, including counties with 10,000 or more Medicare beneficiaries (enclosure 4);
-- top 50 counties in percentage of Medicare beneficiaries enrolled in a risk-based HMO in 1994, including counties with 10,000 or more beneficiaries (enclosure 5);
GAO/HEHS-95-159R HMO Enrollment Data
B-26;414
top 50 counties in percentage increase beneficiaries enrolled in a risk-based including counties with 10,000 or more (enclosure 6);
in Medicare HMO in 1994, beneficiaries
top 50 counties in the increase in total Medicare beneficiaries in risk-based HMOs, including counties with 10,000 or more beneficiaries (enclosure 7);
metropolitan statistical area (SMA) ranked by total Medicare beneficiaries enrolled in risk-based HMOs (enclosure 8); and
breakdown of enrollment data by state and county (enclosure 9).
you or your staff have any questions or would like the enclosed data further analyzed, please call me or Jonathan Ratner, Associate Director, at (202) 512-7119,
Sincerely,
Associate Director Health Financing and Policy Issues
Enclosures - 9
2 GAO/HEHS-95-159R HMO Enrollment Data
ENCLOSURE 1 ENCLOSURE 1
TOT 93 TOT194
RISK93 RISK94
COST93 COST94
FEE93 FEE94
PRISK 93 PRISKr94
PDIF 1994. NDIF
ov75 93 ov75-94 OV85-93 OV85194
HM075-93
HM075-94
HM085-93
HM085-94
P75HM093
P85HM093
P75HM094
P85HM094
VARIABLE DEFINITIONS’
Total number of Medicare beneficiaries, 1993. Total number of Medicare beneficiaries, 1994.
Number of Medicare beneficiaries enrolled in risk-based HMOs in 1993. Number of Medicare beneficiaries enrolled in risk-based HMOs in 1994.
Number of Medicare beneficiaries enrolled in cost-based HMOs in 1993. Number of Medicare beneficiaries enrolled in cost-based HMOs in 1994.
Number of Medicare beneficiaries participating in fee-for-service in 1993. Number of Medicare beneficiaries participating in fee-for-service in 1994.
Percentage of Medicare beneficiaries enrolled in risk-based HMOs in 1993. Percentage of Medicare beneficiaries enrolled in risk-based HMOs in 1994.
Percentage increase or decrease in risk-based HMO enrollment between 1993 and
Difference in the number of Medicare beneficiaries enrolled in risk-based HMOs between 1993 and 1994.
Number of Medicare beneficiaries aged 75 and over, 1993. Number of Medicare beneficiaries aged 75 and over, 1994. Number of Medicare beneficiaries aged 85 and over, 1993. Number of Medicare beneficiaries aged 85 and over, 1994.
Number of Medicare beneficiaries aged 75 and older enrolled in risk-based HMOs, 1993. Number of Medicare beneficiaries aged 75 and over enrolled in risk-based HMOs, 1994. Number of Medicare beneficiaries aged 85 and over enrolled in risk-based HMOs, 1994. Number of Medicare beneficiaries aged 85 and over enrolled in risk-based HMOs, 1994 *
Percentage of Medicare beneficiaries aged 75 and over enrolled in risk-based HMOs, 1993. Percentage of Medicare beneficiaries aged 85 and over enrolled in risk-based HMOs, 1993. Percentage of Medicare beneficiaries aged 75 and over enrolled in risk-based HMOs, 1994. Percentage of Medicare beneficiaries aged 85 and over enrolled in risk-based HMOs, 1994.
‘Figures bas ed on December 1993 and December 1994 enrollment data. A ” . ” indicates that a statistic could not be calculated (for example, a given county had no Medicare beneficiaries enrolled in risk-based HMOs) .
ENCLOSURE 2 ENCLOSURE 2
ENCLOSURE 3 ENCLOSURE 3
ENCLOSURE 4 ENCLOSURE 4
ENCLOSURE 5 ENCLOSURE 5
ENCLOSURE 6 ENCLOSURE 6
ENCLOSURE 7 ENCLOSURE 7
ENCLOSURE 8 ENCLOSURE 8
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