Address correspondence to Vicki A. Freedman, Ph.D., Director, Polisher Research Institute, Madlyn and Leonard Abramson Center for Jewish Life, 1425 Horsham Rd., North Wales, PA 19454. Jonas Marainen was formerly with Polisher Research Institute, Madlyn and Leonard Abramson Center for Jewish Life. Jeannette Rogowski, Ph.D., is a Senior Economist, RAND Health, Arlington, VA. John Adams, Ph.D., is a Senior Statistician, and José J. Escarce, M.D, Ph.D., is a Senior Natural Scientist, with RAND Health, Santa Monica, CA. Additionally, Dr. Escarce is Professor of Medicine, the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles. Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, Minneapolis, MN.
Socioeconomic Disparities in the Use of Home Health Services in a Medicare Managed Care Population
Version of Record online: 26 AUG 2004
Health Services Research
Volume 39, Issue 5, pages 1277–1298, October 2004
How to Cite
Freedman, V. A., Rogowski, J., Wickstrom, S. L., Adams, J., Marainen, J. and Escarce, J. J. (2004), Socioeconomic Disparities in the Use of Home Health Services in a Medicare Managed Care Population. Health Services Research, 39: 1277–1298. doi: 10.1111/j.1475-6773.2004.00290.x
This research was supported by grant RO1-HS/AG09630 from the Agency for Healthcare Research and Quality. We thank Elaine Quiter, M.S., for project administration and Randy Hirsher, Jill Gurvey, and Mona Shah for data support.
- Issue online: 26 AUG 2004
- Version of Record online: 26 AUG 2004
- Home health;
- durable medical equipment (DME);
- access to care;
- managed care;
- health maintenance organization (HMO)
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. We 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.