Medicare+Choice compares unfavorably with traditional fee-for-service Medicare in 9 out of 11 features linked to primary care, according to a study funded by the U.S. Agency for Healthcare Research and Quality that is generating interest and controversy.

The study, published in the April 8 issue of the Archives of Internal Medicine, compares the two systems in 13 states in such categories as access to, and continuity of, primary care.

Also measured were the quality of patient-physician interactions, doctors' knowledge of patients' conditions, preventive counseling, and trust in provider. The findings in "Primary Care Quality in the Medicare Program" are based on surveys by the Centers for Medicare and Medicaid Services conducted in 1998 and 1999.

Susan Pisano, a spokeswoman for the American Association of Health Plans, says that the study tells only part of the story.

"What we basically know from other studies is that both Medicare+Choice and fee-for-service Medicare beneficiaries report high levels of satisfaction with their care, and that there's very little to choose between them. But when you look at the quality of care delivered and affordability, then it is Medicare+Choice hands down."

In addition, she notes, the study does not take into account technical aspects of care.

That's all too true, says Dana Gelb Safran, ScD, the study's lead author.

"Clinical quality of care has two dimensions," says Safran. "It has a technical side and it has an interpersonal side. What we have been able to capture extremely well in our research is that interpersonal side of clinical quality."

She contends that the impact of the interpersonal side of primary care should not be played down.

"There is quite a substantial body of research that says that in health care, particularly in primary care, the quality of interpersonal care is tremendously important," says Safran.

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