Sunday, 16 January 2005 - 8:45 AM

This presentation is part of: Community Health Care of Older Adults

Racial Disparities in Access to Medicare Home Health Care: Implications for Social Work, Policy and Advocacy

The Balanced Budget Act of 1997 altered the reimbursement structure for Medicare home health agencies under the fee for service program. Reimbursements were reduced to 1993 levels and such reductions may have encouraged agencies to alter the amount, duration or type of services provided to patients. Specifically, incentives in the policy changes encouraged agencies to curtail service delivery to the most costly patients. This paper specifically summarizes findings related to utilization of home health care after implementation of the BBA and the differential impact of these policy changes on subgroups of beneficiaries, particularly by race. The study consisted of a secondary analysis of Medicare Current Beneficiary Survey and matching claims data for the years 1996 (pre-policy change) and 1998 (post-policy change) (N=2,407). The study showed that the total number of white users decreased significantly while Hispanic users increased significantly between 1996 and 1998. However, African American users experienced the greatest decrease in both visits and reimbursements between 1996 and 1998. Cross tabulation results showed that those in the “Other” race category experienced the greatest decrease in the proportion of users receiving over 150 visits followed by African Americans and white users. Multivariate, interaction regression models showed that even when controlling for critical predisposing, enabling and need variables, race was still associated with changes in utilization. Being African American was associated with decreased visits (all visit types) and reimbursements in 1998 as compared to white users. Also “other” race was associated with reductions in skilled nursing and medical social work visits in 1998 as compared to white users. These findings continue to raise questions regarding the equitable nature of health care access. Given that the multivariate models controlled for health and functional status, income and education, poorer health or lower SES cannot explain these disparities. In light of the recent National Health Care Disparities Report, both policy and practice implications of these findings will be discussed.

See more of Community Health Care of Older Adults
See more of Oral and Poster

See more of Celebrating a Decade of SSWR (January 13 - 16, 2005)