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To the Editor: From the results of their national survey, Dr Landon and colleagues¹ reported that participants in Medicare fee-for-service (FFS) plans were more satisfied with their access to care and quality of services, but that recipients of Medicare managed care (MMC) received more immunizations and repoted fewer difficulties with paperwork. Although the authors performed case-mix adjustment based on age, education, and health status, I am puzzled that the authors did not assess pharmaceutical use.

All of the MMC programs I have worked with have had some drug coverage included—although, at about the time of the survey, the premium charged by those plans was increasing steeply due to cost increases. It is possible that patients taking multiple medications would be disproportionately likely to choose a managed care plan covering prescription drugs as opposed to standard Medicare with no such coverage. Increasing premiums could be partially responsible for the the lower . . . [Full Text of this Article]

Roger K. Howe, MD, MMM
rogerkhowe@cs.com
Little Rock, Ark

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