Date of Award

8-2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Health and Kinesiology

First Advisor

Laura Sands

Second Advisor

Gerald Hyner

Committee Chair

Laura Sands

Committee Co-Chair

Gerald Hyner

Committee Member 1

David Klenosky

Committee Member 2

Cleveland Shields

Abstract

Medicare provides health care coverage for approximately 93% of non-institutionalized older adults. Compared to uninsured adults, Medicare beneficiaries have greater access to needed healthcare including preventative care. However, disparities in accessing needed health care still exist among Medicare beneficiaries. Prior research has described barriers to accessing needed health care among older Medicare beneficiaries, such as transportation and health system characteristics, but little is known about prevalence, risks, or health consequences of older Medicare beneficiaries delaying, forgoing, or having trouble accessing needed health care. The three studies included in this dissertation followed a nationally representative sample of older Medicare beneficiaries to describe the phenomenon of older adults delaying, forgoing, or having trouble getting needed care.

Study 1 described the prevalence and risks of Medicare beneficiaries forgoing, delaying, or having trouble getting needed medical care. Estimates of the prevalence and risks for forgoing, delaying, or having trouble accessing needed care were estimated separately for five years beginning with 2006 and ending in 2010 using the Medicare Current Beneficiary Survey (MCBS). A meta-analysis was conducted to determine overall effect sizes for the five years of data. Study results revealed that about one in every nine older Medicare beneficiaries reported forgoing, delaying, or having trouble accessing needed health care. Beneficiaries most likely to report going without or having trouble getting needed care were more likely to be of minority status, younger, female, more educated, live in a non-metropolitan area, have a lower annual income, have no supplementary insurance, be in poorer health, and have multiple chronic conditions or disabilities. This study confirmed that disparities in accessing needed care exist among Medicare beneficiaries. The study findings also revealed that those most likely to delay, forgo, or have trouble accessing needed care are among the most vulnerable Medicare beneficiaries due to their multiple chronic conditions or disabilities.

The second study examined whether reports of forgoing, delaying, or having trouble accessing needed health care was prognostic of receiving an influenza vaccination in the following year. This study followed the 2006-cohort and 2007-cohort from the 2007 Medicare Current Beneficiary Survey to determine if receipt of the influenza vaccination in 2008 was associated with forgoing, delaying, or having trouble accessing needed health care. Nearly one in every four older Medicare beneficiaries reported not receiving an influenza vaccination. Those who reported forgoing, delaying, or having trouble accessing needed health care were significantly less likely (OR = 0.749; 95% CI = 0.609, 0.922) to receive an influenza vaccination the following year. Findings suggest that forgoing, delaying, or having trouble accessing needed healthcare increases risk for vaccination non-compliance; which in turn can increase risk for experiencing adverse health outcomes associated with influenza. The results of this study suggest that more proactive measures may be needed to increase vaccination rates among older adults who forgo, delay, or have trouble accessing needed health care.

Study 3 examined whether reports of forgoing, delaying, or having trouble accessing needed care were prognostic of hospital admissions among older Medicare beneficiaries. Number and length of hospital admissions in 2010 were determined for respondents to the 2009 MCBS survey. Results revealed that forgoing, delaying, or having trouble accessing needed care was not prognostic (Hazards Ratio = 0.905; 95% CI = 0.722, 1.134) of future hospital admissions after adjusting for other risk factors associated with hospitalizations. Findings suggest that there may be potential confounding between forgoing, delaying, or having trouble accessing needed health care and hospital admissions. Further work should be considered to examine potential confounders and/or other health outcomes.

The three studies in this dissertation improve our understanding of the prevalence, risks, and consequences of older Medicare beneficiaries forgoing, delaying, or having trouble accessing needed health care. The findings will inform the importance of developing interventions or policies aimed at improving older Medicare beneficiaries’ access to needed health care.

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