Access to Health Care Among Three Cohorts of Older Americans Residing in a Rural State

Abstract

Three cohorts of older Americans are examined to determine how they perceive the likelihood of being able to access health care in the future. A modified Andersen (1968) model provides the framework for the study. A representative sample of 2,404 noninstitutionalized midwestern older persons separated into three age cohorts (60-69, 70-79, and 80+ ) was used. Predisposing, enabling, and need factors were examined by logistic regression. Significant differences were found between age cohorts, with the perceptions of the oldesi-old and the youngest-old appearing to be markedly more sensitive than those of the middle-old. Need factors of health and the respondents' perceptions of help they needed with instrumental activities of daily living, and enabling factors of community size and the barrier imposed by lack of transportation, combined to explain the perceptions of the oldest-old. For the youngest-old, the significant variables were bills, gender, barriers imposed by inadequate insurance, lack of transportation, and a perception that physicians charged more than allowed by Medicare. Recommendations are made for health care policy with respect to different age cohorts among the elderly, their families, and the rurality of the population.

Utilization of community-based services among homeless persons: An application of a theoretical model

“…Finally, the need component of the model includes perceived or evaluated needs of the individual's physical and behavioral health status. In studies using the Andersen model, need-based factors often represent the most immediate determinants of service utilization and have been shown to explain the largest share of variance in utilization (Aday & Andersen, 1974;Andersen & Newman, 1973;Mercier & Shelley, 1997;Padgett et al, 1990).…”

“…Although the model was initially applied to study the use of health care services, it has been extended to other service types for various populations (Bass & Noelker, 1987;Calsyn & Roades, 1993;Freedman, 1993;Mercier & Shelley 1997;McCaslin, 1989;Miller & McFall, 1991;Padgett, Patrick, Burns, & Schlesinger, 1994).…”

Age and sex differences in the association between access to medical care and health outcomes among older Chinese

“…Likewise, research has shown that the factors influencing access to medical care vary by age in later life. For example, higher co-pay and lack of insurance coverage are often attributed to lower self-reported accessibility to healthcare among the youngest-old adults (aged 60–69); whereas greater needs due to poor health and lack of transportation are more often attributed to lower accessibility of care among the oldest-old adults (aged 80 or older) [35].…”

Health Care in Rural Texas

“…Older Americans often wrestle with poor health. A sample of 2,404 noninstitutionalized Midwestern older persons in three age cohorts (Mercier & Shelley, 1997) found that rural elderly have higher rates of chronic illness and generally poorer health. Heard-Mueller, Darville, and Watson (1 994) discovered different patterns in health care utilization between black and white elderly rural women in Texas.…”