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December 25, 1996

The Elderly and Poor in the Medical Outcomes Study-Reply

Author Affiliations

New England Medical Center Boston, Mass

JAMA. 1996;276(24):1953. doi:10.1001/jama.1996.03540240031020

In Reply.  —We agree with the need for better understanding quasi-experimental (observational) methods for monitoring health care. Methods like those used in the MOS1 will provide most of the information about changes in the utilization of health care services and health outcomes following health care reform.We disagree with Drs Barrett and Juhn that MOS conclusions were based on "inconsistent results" and "novel" contrasts. Contrasts were planned in advance,1 and results were consistent.2 As documented in Tables 4 and 5 of our article2 for analyses of both average changes and categories of change, we could reject the hypothesis that the differences between FFS and HMO systems in physical health were the same across elderly and nonelderly and across poor and nonpoor subgroups. The change score cut points were based on other studies3,4 and were not subject to gaming. Including elderly patients who died in the worse category