Avoidance of health care services because of cost: Impact of the medicare savings program

Health Affairs

Volumn 24, Issue 1, 2005, Pages 263-270

  Federman, Alex D ^a   Vladeck, Bruce C ^b   Siu, Albert L ^c  

^a MOUNT SINAI HOSPITAL   (United States)

^b Mt Sinai's Department of Geriatrics   (Egypt)

^c Medicine   (Italy)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST BENEFIT ANALYSIS; DEMOGRAPHY; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH SERVICE; HUMAN; LOWEST INCOME GROUP; MEDICAL FEE; MEDICAL RESEARCH; MEDICARE; TREATMENT REFUSAL;

AGED; DATA COLLECTION; HEALTH SERVICES; HUMANS; MEDICARE; UNITED STATES;

EID: 12944260430     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.24.1.263     Document Type: Article

References (21)

1. M.E. Gluck, Medicare Chart Book (Menlo Park, Calif.: Henry J. Kaiser Family Foundation, Fall 2001).
2. The 2003 federal poverty level was $8,980 for individuals and $12,120 for couples. For data on beneficiary spending, see S. Crystal et al., "Out-of-Pocket Health Care Costs among Older Americans," Journals of Gerontology Series B: Psychological Sciences and Social Sciences 55S, no. 1 (2000): S51-62; and D.J. Gross et al., "Out-of-Pocket Health Spending by Poor and Near-Poor Elderly Medicare Beneficiaries," Health Services Research 34, no. 1, Part 2 (1999): 241-54.
3. The 2003 federal poverty level was $8,980 for individuals and $12,120 for couples. For data on beneficiary spending, see S. Crystal et al., "Out-of-Pocket Health Care Costs among Older Americans," Journals of Gerontology Series B: Psychological Sciences and Social Sciences 55S, no. 1 (2000): S51-62; and D.J. Gross et al., "Out-of-Pocket Health Spending by Poor and Near-Poor Elderly Medicare Beneficiaries," Health Services Research 34, no. 1, Part 2 (1999): 241-54.
4. Henry J. Kaiser Family Foundation, "Medicare Advantage Fact Sheet" (Menlo Park, Calif.: Kaiser Family Foundation, March 2004).
5. K. Glaun, Medicaid Programs to Assist Low-Income Medicare Beneficiaries: Medicare Savings Programs Case Study Findings (Menlo Park, Calif.: Kaiser Commission on Medicaid and the Uninsured, May 2003).
6. Ibid.; J.A. Lamphere and M.L. Rosenbach, "Promises Unfulfilled: Implementation of Expanded Coverage for the Elderly Poor," Health Services Research 35, no. 1, Part 2 (2000): 207-217; S.T. Parente, W.N. Evans, and E.J. Bayer, The Impact of QMB Enrollment on Medicare Costs and Service Utilization (Bethesda, Md.: Project HOPE Center for Health Affairs, July 1995); and P.J. Neumann et al., Identifying Barriers to Elderly Participation in the Qualified Medicare Beneficiary Program, Report to the Health Care Financing Administration (Bethesda, Md.: Project HOPE CHA, August 1994).
7. Ibid.; J.A. Lamphere and M.L. Rosenbach, "Promises Unfulfilled: Implementation of Expanded Coverage for the Elderly Poor," Health Services Research 35, no. 1, Part 2 (2000): 207-217; S.T. Parente, W.N. Evans, and E.J. Bayer, The Impact of QMB Enrollment on Medicare Costs and Service Utilization (Bethesda, Md.: Project HOPE Center for Health Affairs, July 1995); and P.J. Neumann et al., Identifying Barriers to Elderly Participation in the Qualified Medicare Beneficiary Program, Report to the Health Care Financing Administration (Bethesda, Md.: Project HOPE CHA, August 1994).
8. Ibid.; J.A. Lamphere and M.L. Rosenbach, "Promises Unfulfilled: Implementation of Expanded Coverage for the Elderly Poor," Health Services Research 35, no. 1, Part 2 (2000): 207-217; S.T. Parente, W.N. Evans, and E.J. Bayer, The Impact of QMB Enrollment on Medicare Costs and Service Utilization (Bethesda, Md.: Project HOPE Center for Health Affairs, July 1995); and P.J. Neumann et al., Identifying Barriers to Elderly Participation in the Qualified Medicare Beneficiary Program, Report to the Health Care Financing Administration (Bethesda, Md.: Project HOPE CHA, August 1994).
9. Ibid.; J.A. Lamphere and M.L. Rosenbach, "Promises Unfulfilled: Implementation of Expanded Coverage for the Elderly Poor," Health Services Research 35, no. 1, Part 2 (2000): 207-217; S.T. Parente, W.N. Evans, and E.J. Bayer, The Impact of QMB Enrollment on Medicare Costs and Service Utilization (Bethesda, Md.: Project HOPE Center for Health Affairs, July 1995); and P.J. Neumann et al., Identifying Barriers to Elderly Participation in the Qualified Medicare Beneficiary Program, Report to the Health Care Financing Administration (Bethesda, Md.: Project HOPE CHA, August 1994).
10. The survey was conducted by Dana Gelb Safran and colleagues at Tufts-New England Medical Center and was supported by the Commonwealth Fund and the Henry J. Kaiser Family Foundation. See D.G. Safran et al., "Prescription Drug Coverage and Seniors: How Well Are States Closing the Gap?" Health Affairs, 31 July 2002, content.healthaffairs.org/cgi/content/abstract/hlthaff.w2.253 (25 October 2004).
11. Missing data were greatest for type of disease (6.1 percent missing), education (5.7 percent), number of medications used (5.7 percent), and type of primary care practice (5.1 percent). For a description of multiple imputation, see J.L. Schafer, "Multiple Imputation: A Primer," Statistical Methods in Medical Research 8, no. 1 (1999): 3-15.
12. J. Zhang and K.F. Yu, "What's the Relative Risk? A Method of Correcting the Odds Ratio in Cohort Studies of Common Outcomes," Journal of the American Medical Association 280, no. 19 (1998): 1690-1691.
13. Sixteen percent of seniors with incomes below 100 percent of poverty lacked supplemental coverage in 1997. See Gluck, Medicare Chart Book.
14. Lamphere et al., "Promises Unfulfilled"; Glaun, Medicaid Programs; Parente et al., The Impact of QMB Enrollment; and M. Moon, N. Brennan, and N. Segal, "Options for Aiding Low-Income Medicare Beneficiaries," Inquiry 35, no. 3 (1998): 346-356.
15. Lamphere et al., "Promises Unfulfilled"; Glaun, Medicaid Programs; Parente et al., The Impact of QMB Enrollment; and M. Moon, N. Brennan, and N. Segal, "Options for Aiding Low-Income Medicare Beneficiaries," Inquiry 35, no. 3 (1998): 346-356.
16. Lamphere et al., "Promises Unfulfilled"; Glaun, Medicaid Programs; Parente et al., The Impact of QMB Enrollment; and M. Moon, N. Brennan, and N. Segal, "Options for Aiding Low-Income Medicare Beneficiaries," Inquiry 35, no. 3 (1998): 346-356.
17. Lamphere et al., "Promises Unfulfilled"; Glaun, Medicaid Programs; Parente et al., The Impact of QMB Enrollment; and M. Moon, N. Brennan, and N. Segal, "Options for Aiding Low-Income Medicare Beneficiaries," Inquiry 35, no. 3 (1998): 346-356.
18. Parente et al., The Impact of QMB Enrollment; and R.J. Ozminkowski, A. Aizer, and G. Smith, "The Value and Use of the Qualified Medicare Beneficiary Program: Early Evidence from Tennessee," Health and Social Work 22, no. 1 (1997): 12-19.
19. Parente et al., The Impact of QMB Enrollment; and R.J. Ozminkowski, A. Aizer, and G. Smith, "The Value and Use of the Qualified Medicare Beneficiary Program: Early Evidence from Tennessee," Health and Social Work 22, no. 1 (1997): 12-19.
20. Glaun, Medicaid Programs.
21. I b i d.