Disability Stages and Trouble Getting Needed Health Care Among Medicare Beneficiaries

Abstract

OBJECTIVE To examine whether activity limitation stages were associated with patient-reported trouble getting needed health care among Medicare beneficiaries. DESIGN A population-based study (n= 35,912) of Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey (MCBS) for years 2001–2010. Beneficiaries were classified into an activity limitation stage from 0 (no limitation) to IV (complete) derived from self- or proxy-reported difficulty performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Beneficiaries reported whether or not they had trouble getting health care in the subsequent year. A multivariable logistic regression model examined the association between activity limitation stages and trouble getting needed care. RESULTS Compared to beneficiaries with no limitations (ADL stage 0), the adjusted odds ratios (OR) (95% confidence intervals (CIs)) for stage I (mild) to stage IV (complete) for trouble getting needed health care ranged from OR = 1.53 (95% CI: 1.32–1.76) to OR = 2.86 (95% CI: 1.97–4.14). High costs (31.7%), not having enough money (31.2%), and supplies/services not covered (24.2%) were the most common reasons for reporting trouble getting needed health care. CONCLUSION Medicare beneficiaries at higher stages of activity limitations reported trouble getting needed healthcare which was commonly attributed to financial barriers.

Characteristics of community-dwelling older individuals who delayed care during the COVID-19 pandemic

“…The pre-pandemic literature shows that people with disabilities were less likely to receive recommended care, such as follow-up visits after hospital discharge, care for chronic conditions, preventive medical care, and dental care ( Iezzoni, 2011 ; Na et al., 2017 ). Their long-lasting barriers to care included financial difficulty, lack of usual source of care, inadequate insurance coverage, transportation, and refusal of services by providers as barriers to care ( Chen et al., 2020 ; Kurichi et al., 2017 ; McClintock et al., 2017 ; Spencer et al., 2009 ). Thus, financial difficulty was a persistent barrier among this population, especially during the pandemic period characterized by increased unemployment and unstable incomes.…”

Health Care Accessibility for Individuals With Disabilities: Barriers and Risk Factors Impacting Care

“…Despite the implementation of various legislative measures including the Americans with Disability Act and, more recently, the Patient Protection and Affordable Care Act, disparity still exists in the provision of health care. The most commonly cited barriers include transportation 5,7,9-11,14,19-20, care coordination 4-5,9-11,14, and physical access to a health care provider 7,10-11,14,19-20. Certain groups are more likely to experience these barriers to care, the most commonly cited significant factors being age 9-10,13,15-16,19,21, race/ethnicity 9,[12][13][15][16][17][18][19][20][21] , and gender 10,15,[18][19] .…”

Near Vision but not Hearing Loss is Associated with Lacking a Usual Source of Health Care

“…People with disabilities are at risk of having unmet healthcare needs, in part because they may have more difficulties in accessing primary care clinics, difficulties that are worsened among older adults (Popplewell et al, 2014). Similarly, worsening functional impairment is associated with increased difficulties in obtaining necessary health care (McClintock et al, 2017). Transportation issues and having medical offices that are accessible are particularly salient barriers for accessing health services among people with disabilities residing in rural communities who may live far away from their healthcare providers (Iezzoni et al, 2006).…”