SES DIFFERENCES IN HMO UTILIZATION BY OLDER AMERICANS

参加管理型医疗的老年医疗保险受益人人数 计划在过去几年中迅速增长，最近在 医疗保险可能会加速这一趋势。因为托管cre计划使用 财政奖励和非财政机制，以遏制使用， 有人担心，这些计划中的老年人可能面临障碍， 接受适当的医疗护理。这一担忧尤为严重。 关于社会经济地位较低的老年人。尽管 对管理性医疗对医疗服务使用的影响的广泛关注 由弱势老年人口提供的服务，目前几乎没有 对这一问题的研究。 提出的项目是一项为期三年的观察研究，旨在了解 老年人医疗服务利用的社会经济状况 医疗保险受益人登记在医疗保健组织，并代表一个协作性 兰德研究人员与医疗保健中心之间的合作 领先的管理型医疗机构United Health Care的政策和评估 组织。该项目的目标是评估SES的影响 打开： 1.医生就诊、初级保健医生就诊和就诊总数 给专家； 2.拜访非内科医生提供者； 3.住院率和住院时间； 4.利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。 该项目的次要目标是提供有关 SES影响管理型护理中老年人利用的途径 计划。 该项目将评估注册人员在3年内的使用体验 隶属于UHC的地理上分散的Medicare HMO。 数据来源将包括对参与者的电话调查和 这项研究的管理数据来自医疗保健组织。确定SES的效果 在利用率方面，我们将估计多变量回归模型 对健康状况和其他因素的综合衡量的控制 这可能会影响对医疗保健的需求。 该项目的成果将提供重要的新信息 政策制定者和医疗保健主任关于老年人情况的计划 在管理式医疗系统中的低SES费用的人，旨在 控制使用率。这些未被研究的问题尤其是 鉴于医疗保险的数量不断增加，需要解决的重要问题 将在管理性医疗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.