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National Healthcare Disparities Report, 2004

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4. Types of Data

The standardized table shells were used to compare and contrast information on selected measures of access, use and expenditures, and quality of care for elderly persons living in communities. The measures and methods used to construct them are described below:

Expenditure Tables

The MCBS Cost and Use files contain charge and payment information for each service received by a sample person. The charge is the amount to which a provider was legally entitled to collect for the service, and it is equal to the sum of payments from eleven potential payers. One of the eleven potential payers is "amount discount," which is used to account for any difference between the allowed charge and payments from the other ten sources. Assume, for example, a provider was entitled to $100 for an office consultation and the sum of payments from the patient and third party payers such as Medicare, Medicaid, and private insurance was $90. The remaining $10 to which the provider was entitled would be considered uncollected liability and assigned to "amount discount" to make the sum of payments by the eleven sources equal the allowed charge.

Total expenditures in tables prepared for the NHDR are defined as the sum of payments from all sources except amount discount. The payments represent the amounts received by providers for their services. The ten sources from which a provider might receive payment include Medicare, Medicaid, Medicare HMO, private HMO, Veterans Administration, employer-sponsored private insurance, individually purchased private insurance, private insurance from an unknown source, the sample person, and public health plans other than Medicare or Medicaid.

Two sets of tables were created to compare and contrast mean outlays for all services and for prescription drug purchases by elderly community residents. One set includes all of the elderly community residents in the sample (per capita expenditure tables). The other set includes only the elderly community residents with expenditures (per user expenditure tables).

User Rate Tables

User rate tables were created to compare and contrast the proportion of beneficiaries with expenditures for inpatient hospital services and for prescription medicine purchases. Separate tables were created for inpatient hospital services and for prescription drug purchases. Users are defined as persons with an expense for at least one of the relevant services, and user rates are calculated as the proportion of persons with an expense in each cell in the standardized tables.

Source of Payment Tables

Two sets of tables were created to show the proportion of expenses paid out-of-pocket for all services and for prescription medicines. The out-of-pocket share of total expenditures in these tables is defined as the sum of out-of-pocket payments by all persons in a cell divided by their total expenditures.

Access and Satisfaction Tables

Six sets of tables were created to assess dimensions of access to and satisfaction with health care by elderly community residents. The tables are based on responses to the following questions about medical care received in the year preceding the interview:

  • The "Usual Source of Care" tables show the proportion of persons who did not have access to a particular medical person or clinic when they were sick or needed medical advice.
  • The "Had Trouble Getting Care" tables show the proportion of persons who reported difficulty getting care that they wanted or needed.
  • The "Delayed Care Due to Cost" tables show the proportion of persons who reported that they delayed seeking care because they were worried about the cost.
  • The "Quality of Care" tables show the proportion of persons who were dissatisfied or very dissatisfied with the overall quality of care received during the previous twelve months.
  • The "Availability of Care" tables show the proportion of persons who were dissatisfied or very dissatisfied with the availability of care at night and on weekends.
  • The "Ease of Getting to a Doctor" tables show the proportion of persons who were dissatisfied or very dissatisfied with the ease and convenience of getting to a doctor from their residence.

All of the tables show the proportion of negative responses by persons within a cell. The denominator for the proportions includes the total population of the cell regardless of how the sample person responded to the question. For questions concerning satisfaction with care, the denominator for a cell may include persons who reported no experience with the dimension of health care about which the question asked.

Computation of Statistics and Standard Errors

The counts, means, and proportions in the tables are weighted to reflect the "ever enrolled" Medicare population in the relevant data year. In addition, standard errors are included in the tables in order to assess the impact of sampling variability on the accuracy of the estimates. They were estimated by using a software package (SUDAAN) that accounts for the impact of non-random sampling procedures on the precision of the weighted estimates.

Not all table cells have a value. If a cell had fewer than 30 observations or the relative standard error of the estimate was greater than 30, the value for that cell was suppressed. This rule was implemented to avoid reporting statistically unreliable estimates of the characteristics of elderly community residents.

 

 

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