Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #107659

Brenda R. Wamsley, PhD, Department of Social Work, West Virginia State University, 928 Wallace Hall, P.O. Box 1000, Institute, WV 25112, 304-766-5240, wamsleyb@wvstateu.edu and Gerald Eggert, PhD, Executive Director, Monroe County Long Term Care Program, Inc, P.O. Box 429, East Rochester, NY 14445.

To date only one study, “A Randomized Controlled Trial of Primary and Consumer-Directed Care” (CMS #95-C-90467/2-01), has evaluated consumer-direction within the context of Medicare. This paper uses data from a rural analysis of this Medicare Demonstration to report on satisfaction of rural (non-MSA) and urban (MSA) samples of functionally impaired Medicare beneficiaries with three models of consumer-direction: 1) a consumer-directed Voucher (up to $250/month with a 20% co-payment) for in-home care; 2) a Health Promotion Nurse (HPN) to empower beneficiaries to take greater responsibility for disease self-management and health promotion; and 3) a combination of the Voucher and HPN. Key findings indicate that both rural and urban Medicare beneficiaries were highly satisfied in general at 10 months and 20 months with the three consumer-directed models (using a 5-point scale with 1=low and 5=high satisfaction). There were no significant differences between the rural (non-MSA) and urban (MSA) samples on most measures of satisfaction. There was, however, evidence to suggest that a rural population may desire more staff support in managing a consumer-directed Voucher benefit than their urban counterparts (p<.01). Urban participants in the HPN model were more likely than rural participants to report satisfaction that their overall health improved over the course of the intervention (p<.05). Implications for Medicare reform will be discussed.

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