Disparities in Receipt of Recommended Care Among Younger Versus Older Medicare Beneficiaries: a Cohort Study

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2017 Mar 31

PMID 28356149

Citations 2

Authors

Ling Na

Joel E Streim

Liliana E Pezzin

Jibby E Kurichi

Dawei Xie

Hillary R Bogner

Pui L Kwong

Steven M Asch

Sean Hennessy

Affiliations

Soon will be listed here.

Abstract

Background: Although health disparities have been documented between Medicare beneficiaries based on age (<65 years vs. older age groups), underuse of recommended medical care in younger beneficiaries has not been thoroughly investigated. In this study, we aim to identify and characterize vulnerabilities of the younger Medicare age group (aged <65 years) in relation to older age groups (aged 65-74 years and ≥75 years) and to explore age group as a determinant of use of recommended care among Medicare beneficiaries.

Methods: We conducted a cohort study of community-dwelling Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey between 2001 and 2008 (N = 30,117). Age group characteristics were compared using cross-sectional data at baseline. During follow-up, we assessed the association between age and receipt of recommended care on 38 recommended care indicators, adjusting for sociodemographic and clinical characteristics. Follow-up periods differed by component indicator.

Results: At baseline, a higher proportion of younger beneficiaries experienced social disadvantage, disability and certain morbidities than older age groups. During follow-up, younger beneficiaries were significantly less likely to receive overall recommended care compared to those 65-74 years of age (adjusted odds ratio and 95% confidence interval: 0.75, 0.70-0.80). In addition, male gender, non-Hispanic black race, less than high school education, living alone, with children or with others, psychiatric disorders and higher activity limitation stages were all associated with underuse of recommended care.

Conclusions: Younger Medicare beneficiary status appears to be an independent risk factor for underuse of appropriate care. Support to ameliorate disparities in different social and health aspects may be warranted.

Citing Articles

Marginalized two part model for analyzing multilevel semicontinuous medical costs in Iranian households.

Daghaghele E, Angali K, Kamyari N, Seyedtabib M Sci Rep. 2025; 15(1):7491.

PMID: 40032955 PMC: 11876334. DOI: 10.1038/s41598-025-91309-0.

Comparison of Ambulatory Care Access and Quality for Beneficiaries With Disabilities Covered by Medicare Advantage vs Traditional Medicare Insurance.

Johnston K, Wen H, Pollack H JAMA Health Forum. 2022; 3(1):e214562.

PMID: 35977235 PMC: 8903104. DOI: 10.1001/jamahealthforum.2021.4562.

Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.

Song L, Newhouse J, Garcia-De-Albeniz X, Hsu J Health Serv Res. 2019; 54(4):839-850.

PMID: 30941767 PMC: 6606542. DOI: 10.1111/1475-6773.13150.

References

Cubanski J, Neuman P . Medicare doesn't work as well for younger, disabled beneficiaries as it does for older enrollees. Health Aff (Millwood). 2010; 29(9):1725-33. DOI: 10.1377/hlthaff.2009.0962. View

Dansky K, Brannon D, Shea D, Vasey J, Dirani R . Profiles of hospital, physician, and home health service use by older persons in rural areas. Gerontologist. 1998; 38(3):320-30. DOI: 10.1093/geront/38.3.320. View

Fiscella K, Franks P, Gold M, Clancy C . Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000; 283(19):2579-84. DOI: 10.1001/jama.283.19.2579. View

Betancourt J, Green A, Carrillo J, Ananeh-Firempong 2nd O . Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003; 118(4):293-302. PMC: 1497553. DOI: 10.1093/phr/118.4.293. View

Bjorkenstam E, Ljung R, Burstrom B, Mittendorfer-Rutz E, Hallqvist J, Ringback Weitoft G . Quality of medical care and excess mortality in psychiatric patients--a nationwide register-based study in Sweden. BMJ Open. 2012; 2:e000778. PMC: 3289986. DOI: 10.1136/bmjopen-2011-000778. View

Kautter J, Khatutsky G, Pope G, Chromy J, Adler G . Impact of nonresponse on Medicare Current Beneficiary Survey estimates. Health Care Financ Rev. 2007; 27(4):71-93. PMC: 4194960. View

Iezzoni L . Quality of care for Medicare beneficiaries with disabilities under the age of 65 years. Expert Rev Pharmacoecon Outcomes Res. 2010; 6(3):261-73. DOI: 10.1586/14737167.6.3.261. View

Braveman P, Gruskin S . Defining equity in health. J Epidemiol Community Health. 2003; 57(4):254-8. PMC: 1732430. DOI: 10.1136/jech.57.4.254. View

Kizer K . The emerging imperative for health care quality improvement. Acad Emerg Med. 2002; 9(11):1078-84. DOI: 10.1111/j.1553-2712.2002.tb01561.x. View

10.

Kennedy J, Tuleu I . Working age Medicare beneficiaries with disabilities: population characteristics and policy considerations. J Health Hum Serv Adm. 2008; 30(3):268-91. View

11.

Chan L, Doctor J, MacLehose R, Lawson H, Rosenblatt R, Baldwin L . Do Medicare patients with disabilities receive preventive services? A population-based study. Arch Phys Med Rehabil. 1999; 80(6):642-6. DOI: 10.1016/s0003-9993(99)90166-1. View

12.

Min L, Elliott M, Wenger N, Saliba D . Higher vulnerable elders survey scores predict death and functional decline in vulnerable older people. J Am Geriatr Soc. 2006; 54(3):507-11. DOI: 10.1111/j.1532-5415.2005.00615.x. View

13.

Williams D, Rucker T . Understanding and addressing racial disparities in health care. Health Care Financ Rev. 2001; 21(4):75-90. PMC: 4194634. View

14.

Braveman P . Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006; 27:167-94. DOI: 10.1146/annurev.publhealth.27.021405.102103. View

15.

McBean A, Gornick M . Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financ Rev. 1995; 15(4):77-90. PMC: 4193437. View

16.

Laditka J, Laditka S, Probst J . Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality. Health Place. 2009; 15(3):731-40. DOI: 10.1016/j.healthplace.2008.12.007. View

17.

Stineman M, Xie D, Pan Q, Kurichi J, Zhang Z, Saliba D . All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage. J Am Geriatr Soc. 2012; 60(3):485-92. PMC: 3302958. DOI: 10.1111/j.1532-5415.2011.03867.x. View

18.

Roos L, Walld R, Uhanova J, Bond R . Physician visits, hospitalizations, and socioeconomic status: ambulatory care sensitive conditions in a canadian setting. Health Serv Res. 2005; 40(4):1167-85. PMC: 1361193. DOI: 10.1111/j.1475-6773.2005.00407.x. View

19.

Geiger H, Betancourt J, Williams D . Who is at greatest risk for receiving poor-quality health care?. N Engl J Med. 2006; 354(24):2617-9. DOI: 10.1056/NEJMc061028. View

20.

Morgan R, Teal C, Hasche J, Petersen L, Byrne M, Paterniti D . Does poorer familiarity with Medicare translate into worse access to health care?. J Am Geriatr Soc. 2008; 56(11):2053-60. DOI: 10.1111/j.1532-5415.2008.01993.x. View