SES DIFFERENCES IN HMO UTILIZATION BY OLDER AMERICANS

参加管理式护理的老年医疗保险受益人人数 在过去的几年里，计划迅速增长，最近的变化， 医疗保险可能会加速这一趋势。因为管理式cre计划使用 抑制使用的财政激励和非财政机制， 人们担心，这些计划中的老年人可能面临障碍， 接受适当的医疗护理。这一关切尤其严重 社会经济地位低下的老年人。尽管 管理式医疗对医疗使用的影响引起了广泛的兴趣， 弱势老年人口的服务，目前几乎没有 研究这个问题。 该项目是一项为期3年的观察研究， 社会经济地位对老年人医疗服务利用的影响 医疗保险受益人在HMO注册，并代表一个合作 兰德公司和卫生保健中心的研究人员共同努力 政策和评估在联合医疗，一个领先的管理式医疗 organization.该项目的目标是评估SES的影响 日期： 1.医生总就诊次数、初级保健医生就诊次数和 专家; 2.访问非医生提供者; 3.住院率和住院时间; 4.使用急诊室作为护理来源; 5.乳房X光检查和流感疫苗接种率; 6.医疗费用总额。 该项目的第二个目标是提供关于 社会经济地位影响老年人管理式护理利用的途径 布局 本项目将评估注册者的使用经验， 地理上分散的隶属于UHC的Medicare HMO。 数据来源将包括对注册者的电话调查， 来自研究HMO的管理数据。确定SES的影响 在利用率方面，我们将估计多变量回归模型， 控制健康状况和其他因素的综合措施 这可能会影响医疗需求。 该项目的结果将提供重要的新信息， 政策制定者和卫生保健计划的主管， 社会经济地位低的人在管理式保健系统中的待遇， 控制利用率这些未被充分研究的问题尤其 重要的是要解决越来越多的医疗保险 将在管理式护理中接受医疗护理的受益人 设置.

The number of elderly Medicare beneficiaries enrolled in managed care plans has grown rapidly in the past few years, and recent changes in Medicare are likely accelerate this trend. Because managed cre plans use financial incentives and non-financial mechanisms to curb utilization, there is concern that the elderly in these plans may face barriers to receiving appropriate medical care. This concern is especially acute with respect to elderly persons of low socioeconomic status. Despite widespread interest in the impact of managed care on the use of medical services by vulnerable elderly populations, there is currently little research on this issue. The propose project is a 3-year observation study of the influence of socioeconomic status (SES) on the medical care utilization of elderly Medicare beneficiaries enrolled in HMOs, and represent a collaborative effort between investigators at RAND and the Center for Health Care Policy and Evaluation at United Health Care, a leading managed care organization. The goals of the project are to evaluate the impact of SES on: 1. total physician visits, visits to primary care physicians, and visits to specialists; 2. visits to non-physician providers; 3. hospitalization rates and hospital length of stay; 4. use of the emergency room as a source of care; 5. rates of mammography and influenza vaccination; 6. total charges for medical care. A secondary goal of the project is to provide information on the pathways by which SES affects utilization among elders in managed care plans. This project will assess the utilization experience of enrollees in 3 geographically dispersed Medicare HMOs that are affiliated with UHC. Data sources will include a telephone survey of enrollees and administrative data from the study HMOs. To identify the effect of SES on utilization, we will estimate multi-variate regression models that control for comprehensive measures of health status and other factors that may affect the demand for medical care. The results of this project will provide important new information to policy makers and directors of health care plans on how well elderly persons of low SES fare in managed health care systems designed to control utilization. These understudied questions are particularly important to address given the increasing numbers of Medicare beneficiaries who will receive their medical care in managed care settings.