Online Program

Does urgent need for medical care go undetected among seniors with lower SES?

Tuesday, November 5, 2013 : 4:30 p.m. - 4:50 p.m.

Marc N. Elliott, PhD, RAND Corporation, Santa Monica, CA
Brian Finch, PhD, Economics, Sociology and Statistics, RAND Corporation, Santa Monica, CA
Amelia Haviland, PhD, H. John Heinz III College of Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA
Ann Haas, MPH, MS, RAND Corporation, Pittsburgh, PA
Sai Ma, PhD MPA, Division of Consumer Assessment & Plan Performance, Centers for Medicare & Medicaid Services, Baltimore, MD
Robert Weech-Maldonado, MBA, PhD, Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
In data from 340,910 seniors responding to the nationally representative 2010 Medicare CAHPS Survey, 30% reported having “an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office” in the previous 6 months. As expected, this need varied strongly with health status (e.g. 59% of those in poor self-rated health versus 18% of those in excellent self-rated health). We used a two-stage regression model to calculate the health-based probability of urgent care need for each individual and then examined variations in perceived need by educational attainment. While seniors with lower educational attainment reported somewhat higher levels of urgent care need in unadjusted analyses (e.g. 36% of those who did not attend high school versus 30% of those with postgraduate degrees), this difference was smaller than would be expected given the striking health differences by educational attainment. In multivariate models controlling for multiple health measures, age, and gender, seniors who did not complete high school had 63-77% the odds of reporting the need for urgent care of otherwise similar seniors with postgraduate education (p<0.0001), with larger effects for those in poor health (p<0.05 for interactions). Thus differences in perceived need for urgent care may be one factor underlying socioeconomic gradients in health and mortality. Efforts should be made to assist seniors with lower health literacy in their awareness of important symptoms, improve the clarity of provider communication with seniors, and assist seniors with lower health literacy in interactions with the health care system.

Learning Areas:

Assessment of individual and community needs for health education
Biostatistics, economics
Provision of health care to the public
Public health or related education
Public health or related research
Social and behavioral sciences

Learning Objectives:
Discuss how often medical needs go undetected among seniors with low educational attainment. Describe rates of identified need for urgent care among seniors.

Keyword(s): Survey, Social Inequalities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am/have been the principal/co-principal of multiple federally-funded grants/contracts regarding socioeconomic disparities, in addition to being the PI of the project collecting the data. I have published more than 200 articles in peer reviewed publications in this area and currently serve on the editorial boards of HSR, Medical Care R&R, and Public Opinion Quarterly. My scientific research interests include Medicare policy, vulnerable populations and health disparities, consumer evaluation of healthcare, statistical analyses, and survey methodology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.