Abstract
Purpose. The purpose of this study was to identify the manner and extent to which rationing of medical care occurs within Medicare Managed Care Plans. This study sought to uncover the "invisible" rationing of medical care and make this rationing "visible," demonstrate how prevalent rationing of medical care is, and how rationing of medical care occurs within these plans. This study also sought to demonstrate the variation in the forms of rationing of medical care that occur across these plans. Theoretical analysis. Medicare Managed Care Plans show evidence of using various types of "rationing" of medical care. Also, there is some variation in the forms of "rationing" of medical care present across these plans. For the provider, these rationing techniques are seen as mechanisms for efficiency. For the consumer, these rationing techniques raise questions of optimum care. Methodology. This study was an exploratory study that utilized a case study research design where Medicare Managed Care Plans in one Health Care Financing Administration service area were studied. Data were collected utilizing content analysis. Findings. Medicare Managed Care Plans used various types of "rationing" of medical care, and this study identified fifteen types. There is some variation in the forms of "rationing" of medical care present across Medicare Managed Care Plans, and this study identified nine forms. Conclusions and recommendations. This study found many types of "rationing" of medical care that Medicare Managed Care Plans use. One of the concerns that arose was that many of these types of "rationing" are "invisible." This study found some variation in the forms of "rationing" of medical care present across Medicare Managed Care Plans. Also, this study found some of these plans will not nor are required to provide their "Evidence of Coverage" documents until the elderly have enrolled. Therefore, it is recommended that legislation be passed that require insurance plans to provide their "Evidence of Coverage" documents to consumers before they enroll. Also, it is recommended that managed care plans should identify and state they ration medical care, and why this is necessary to keep costs at a reasonable level.