Socioeconomic Disparities in the Use of Home Health Services in a Medicare Managed Care Population

Published In: HSR, Health Services Research, v. 39, no. 5, Oct. 2004, p. 1277-1297

Posted on RAND.org on December 31, 2003

by Vicki A. Freedman, Jeannette Rogowski, Steven L. Wickstrom, John L. Adams, Jonas Marainen, Jose J. Escarce

OBJECTIVE: To investigate socioeconomic disparities in access to home health visits and durable medical equipment by persons enrolled in two Medicare managed care health plans. DATA SOURCES: A telephone survey of 4,613 Medicare managed care enrollees conducted between April and October of 2000 and linked to administrative claims for a subsequent 12-month period. STUDY DESIGN: The authors estimated a series of logistic regression models to determine which socioeconomic factors were related to home health visits and the use of durable medical equipment (DME) among Medicare managed care enrollees. PRINCIPAL FINDINGS: Controlling for health and demographic differences, Medicare managed care enrollees in the lowest tertile for nonhousing assets had 50 percent greater odds than those in the highest tertile of having one or more home health visits. All else equal, enrollees with less than a high school education had 30 percent lower odds than those who had graduated from high school of using durable medical equipment. CONCLUSIONS: Medicare managed care enrollees of low socioeconomic status do not appear to have reduced access to home health visits; however, use of durable medical equipment is considerably lower for enrollees with less than a high school education. Physicians and therapists working with Medicare managed care enrollees may want to actively target DME prescriptions to those with educational disadvantages.

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