RESUMO
OBJECTIVE: To compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). DATA SOURCES: Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. STUDY DESIGN: Multivariate linear regression was used to test whether case-mix-adjusted associations between depressive symptoms and patient experience differed for beneficiaries in MA versus FFS. Dependent measures included four measures of beneficiaries' experiences with doctors (e.g., reports of doctor communication) and seven measures of beneficiaries' experiences with plans (e.g., customer service). PRINCIPAL FINDINGS: Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. CONCLUSIONS: Disparities in care experienced by older Medicare beneficiaries with depressive symptoms tend to be more negative in managed care than in FFS. Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment.
Assuntos
Depressão/psicologia , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicare/estatística & dados numéricos , Satisfação do Paciente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comunicação , Depressão/epidemiologia , Escolaridade , Feminino , Nível de Saúde , Disparidades em Assistência à Saúde , Humanos , Modelos Lineares , Masculino , Relações Médico-Paciente , Fatores Sexuais , Estados Unidos/epidemiologiaRESUMO
Por medio de este estudio se analiza el papel de las mujeres y de las familias en la producción de los cuidados en salud desde los discursos que producen los equipos de salud y el análisis de las fichas familiares en un CESFAM de una localidad urbano-rural de la Región Metropolitana. Se concluye que a pesar de las reformas modernizadoras impulsadas por el Estado en el sector salud, se perpetúa el lugar tradicional de las mujeres y su condición de género, así como un ideario de familia sustentado en la clásica división sexual del trabajo. Asimismo se aprecia que a pesar de la centralidad del papel de las mujeres en la producción de la salud familiar, este permanece invisibilizado y sólo se transparenta con relación a la responsabilidad de estas en las problemáticas familiares.
We have analyzed the role of women and their families regarding the health group speeches and the analysis of the family records from CESFAM in an urban rural place in the Metropolitan region. It is concluded that in spite of the modern reforms boosted by the state health department the traditional role of women and their genre condition remains the same as well as their way of living supported by the classical sex division in their jobs. At the same time it is observed that in spite of the central role of women in maintaining the family health, this remains unseen and it is only observed in their responsibilities in the family circumstances.