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

Abstract #109177

Nathan D. West, MPA, Health, Social and Economics Research, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, 919-541-6816, nathanwest@rti.org, Shulamit Bernard, PhD, Health Care Quality Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, and Celia R. Eicheldinger, MS, Statistics Divsion, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC 27709.

Data come from the 2003 Medicare CAHPS Fee-for-Service survey, a cross-sectional national survey of 107,893 non-institutionalized respondents enrolled in the Medicare program. The regression models included two variables created from survey responses and information provided from the Enrollment Database: ADL limitation and Medicare Entitlement. Case-mix variables race, ethnicity, insurance status, and personal doctor were also added to the regression models.

In general, we found a linear relationship between extent of disability and CAHPS scores. Regardless of a beneficiary's original Medicare entitlement status, the greater the level of difficulty with ADL functioning, the lower beneficiaries rate the Medicare program and their overall health care. We found this also to be true for composite measures of beneficiaries' experiences with health care services in Medicare, particularly whether or not they received needed care and had good communication with their providers. Compared to beneficiaries with no ADL difficulty, beneficiaries with severe ADL difficulties have disproportionate scores of high dissatisfaction with the Medicare program and their overall health care, and more significant problems receiving good care in the Medicare program.

Our findings suggest that the severity of a disabling condition, as measured by ADLs, does account for variation in expectations and satisfaction in the Medicare program. While prior work demonstrated that Medicare beneficiaries whose original reason for entitlement was disability reported worse experience with their health care, this study suggests that even among these disabled elderly those who have difficulty performing activities of daily living report lower satisfaction and worse experience.

Learning Objectives:

• To examine patterns of reported experiences and satisfaction with health care services among Medicare Fee-for-Service beneficiaries with difficulty or inability in performing activities of daily living (ADL). We differentiate between disability as defined by Medicare entitlement and reported disability as measured by ADL functioning. At the conclusion of the session, the participant in this session will have a better understanding that Medicare beneficiaries with ADL functional limitations and potentially the greatest health care needs experience more barriers and delays to obtaining health care services, despite having insurance coverage offered through the Medicare program.

Keywords: Disability, Medicare

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation