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Medicare managed care enrollees make significant use of home health benefits, but low education limits use of medical equipment

Home health care services play a critical role in both the long-term and acute care of older Americans covered by Medicare. Low-income Medicare beneficiaries enrolled in managed care plans do not appear to have reduced access to home health visits. However, those with less than a high school education are much less likely than high school graduates to receive durable medical equipment (DME, for example, wheelchairs and walkers) for home use, according to a study supported by the Agency for Healthcare Research and Quality (HS09630).

Given the cost-effectiveness and better outcomes of DME for Medicare patients, physicians and therapists should actively target DME prescriptions to the educationally disadvantaged, suggests Vicki A. Freedman, Ph.D., of the Madlyn and Leonard Abramson Center for Jewish Life. In 2000, Dr. Freedman and her colleagues conducted a telephone survey of 4,613 Medicare managed care enrollees. The researchers collected information about participants' sociodemographic characteristics (including educational attainment, household income, and household wealth), health status, family and household structure, and lifetime experiences with health insurance and health care. They linked the survey data to administrative claims data from two Medicare managed care plans for a subsequent 12-month period to determine which socioeconomic factors were related to home health visits and the use of DME for this group.

After controlling for health status and demographic differences, Medicare managed care enrollees in the lowest one-third for liquid (nonhousing) assets had 50 percent greater odds than those in the highest one-third of having one or more home health visits. Minimal copays of Medicare managed care plans may minimize access difficulties of poor enrollees to home health care. On the other hand, those who are wealthier may choose alternatives options such as assisted living or hiring private assistance outside of the Medicare benefits.

All else being equal, those with less than a high school education had 30 percent lower odds of using DME than those who had graduated from high school. Either DME is less likely to be prescribed for these individuals, or they are less likely to purchase equipment due to perceived stigma of device use, not being aware of services, or other reasons.

See "Socioeconomic disparities in the use of home health services in a Medicare managed care population," by Vicki A. Freedman, Ph.D., Jeannette Rogowski, Ph.D., Steven L. Wickstrom, M.S., and others, in the October 2004 Health Services Research 39(5), pp. 1277-1297.

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