Primary Care Experiences of Medicare Beneficiaries, 1998 to 2000

OBJECTIVE: To examine changes in the quality of primary care experienced and reported by Medicare beneficiaries from 1998 to 2000. DESIGN: Longitudinal observational study. SETTING: Thirteen states with large, mature Medicare HMO markets. PARTICIPANTS: Probability sample of noninstitutionalized Medicare beneficiaries aged 65 and older enrolled in traditional Medicare (FFS) or a Medicare HMO. MEASUREMENTS AND MAIN RESULTS: We examined 2‐year changes in 9 measures derived from the Primary Care Assessment Survey (PCAS). The measures covered 2 broad areas of primary care performance: quality of physician‐patient interactions (5 measures) and structural/organizational features of care (4 measures). For each measure, we computed the change in each beneficiary's score (1998 vs 2000) and standardized effect sizes (ES). Results revealed significant declines in 3 measures of physician‐patient interaction quality (communication, interpersonal treatment, and thoroughness of physical exams; P≤ .0001). Physicians’ knowledge of patients increased significantly over the 2‐year period (P≤ .001). Patient trust did not change (P = .10). With regard to structural/organizational features of care, there were significant declines in financial access (P ≤ .001), visit‐based continuity (P