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Medicare enrollees who have disabilities are most dissatisfied with not being able to get to a doctor and the high cost of care

Nearly two-thirds of people insured by Medicare have at least one disabling condition. Although most Medicare enrollees who have disabilities are satisfied with their care, one in ten is not. People with disabilities are most dissatisfied with getting information about their condition(s), costs of care, and the availability and ease of getting to the doctor, according to a study supported by the Agency for Healthcare Research and Quality (HS10223).

Cost dissatisfaction probably reflects inadequate or absent coverage of prescription drugs or the assistive devices (for example, eyeglasses, hearing aids, or mobility aids) that help people who have disabilities perform their daily activities. Also, it may be difficult for some disabled people to get to a doctor. Although some Medicaid programs provide taxi vouchers, Medicare does not.

Redesigning practice settings and procedures, and changing payment policies may offer the only solutions to some of these problems, concludes Lisa I. Iezzoni, M.D. M.Sc., of Beth Israel Deaconess Medical Center. Dr. Iezzoni and her colleagues analyzed responses to the 1996 Medicare Current Beneficiary Survey of both elderly and nonelderly community-dwelling, Medicare-insured people. They calculated the odds of being dissatisfied with five general care quality measures and five access-to-care measures according to five disabling conditions: blind or low vision, deaf or hard of hearing, difficulty walking, difficulty reaching, and problems with manual dexterity.

They adjusted for other factors affecting care satisfaction that ranged from race and household income to insurance type. Of the estimated 33.6 million Medicare beneficiaries surveyed, 64 percent reported at least one disabling condition. Ten percent of younger people (aged 18 to 65) with disabilities were dissatisfied with their care overall compared with 5 percent of younger people without disabilities. Elderly people with any major disability were three to four times more likely than nondisabled elderly individuals to be dissatisfied with care, including overall care quality, access to specialists, followup care, and ease of getting to doctors.

More details are in "Satisfaction with quality and access to health care among people with disabling conditions," by Dr. Iezzoni, Roger B. Davis, Sc.D., Jane Soukup, M.Sc., and Bonnie O'Day, Ph.D., in the International Journal for Quality in Health Care 14(5), pp. 369-381, 2002.

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