Factors Associated With Avoiding Health Care Among Community-Dwelling Medicare Beneficiaries With Type 2 Diabetes

Abstract

Introduction Health care avoidance by Medicare beneficiaries with chronic conditions such as type 2 diabetes can result in adverse health and economic outcomes. The objective of this study was to describe factors associated with choices to avoid health care among Medicare beneficiaries with type 2 diabetes. Methods We used a survey-weighted logistic model and the nationally representative 2016 Medicare Current Beneficiary Survey to analyze data on 1,782 Medicare beneficiaries aged ≥65 with type 2 diabetes, to examine associations between Medicare beneficiaries’ decisions to avoid health care and multiple factors (eg, dissatisfaction with information given by providers, health problems that should have been discussed with providers but were not, worry about health more than other people their age). Results Of our study sample, 26.1% reported they avoid health care. Five factors were associated with avoiding health care: delaying care (vs not) because of costs (adjusted odds ratio [aOR] = 2.06; P = .005); having health problems that should have been discussed with providers but were not (vs having discussions) (aOR = 1.50; P = .04); worrying (vs not) about health more than other people their age (aOR = 2.13; P < .001); self-reporting “other” minority race (vs non-Hispanic White) (aOR = 2.01; P = .006); and education levels. Participants with less than a high school diploma (aOR = 1.95; P = .001) and participants with a high school diploma only (aOR = 1.49; P = .049) were more likely than participants with an education beyond high school to report avoiding health care. Conclusion Approximately 1 in 4 Medicare beneficiaries with type 2 diabetes avoid health care. We found inequities in care-seeking behavior by race/ethnicity and education level. Health care perceptions and lack of appropriate discussion of health care concerns with health care providers are also associated with this behavior. Clinical interventions (eg, improved patient–provider communication) and educational outreach are needed to decrease the numbers of Medicare beneficiaries who avoid health care.

Patient attitudes, experiences, and satisfaction with healthcare and office visit utilization among Medicare beneficiaries with type 2 diabetes

“…However, strategies to support preventative diabetes care at the time of diagnosis, promotion of consistent medication taking behavior, and screening for those at-risk of inconsistent use of healthcare are needed. 8,21,22 Our results highlighted that beneficiaries with diabetes who tried to keep sickness to themselves experienced lower office visit utilization. This specific attitude concerning their health may be present because some individuals perceive their condition to be less serious, leading them to postpone testing to diagnose diabetesrelated complications and medical treatments.…”

Factors Associated with Healthcare Avoidance among US Adults: Analyses of the 2019 Healthy Information National Trends Survey

“…One study found that Medicare beneficiaries with type 2 diabetes that reported lower levels of education (i.e. less than a high school diploma and high school degree) and of "other" racial/ethnic minority status (versus non-Hispanic White) were more likely to avoid healthcare [50]. Continual investigation of avoidant behavior among those with specific health conditions and racial/ethnic will facilitate better understanding of those at risk for avoidance of needed medical care.…”

Receiving or not deemed necessary healthcare services

“…In addition, there are numerous studies investigating avoidance of seeking medical care behavior from gender perspective [ 9 – 11 ], from urban/rural area differences [ 12 , 13 ], from age perspective [ 14 – 17 ]. There are also various studies searching avoidance factors from the specific diseases perspective such as chronic diseases [ 18 ], heart diseases [ 10 , 19 – 23 ], cancer [ 24 ], diabetes [ 25 ], stroke [ 22 ], breast cancer [ 26 – 28 ], HIV [ 29 , 30 ], tuberculosis [ 31 , 32 ], Parkinson [ 33 ], mental health [ 34 – 36 ], osteoarthritis [ 37 ].…”