ACCESS TO CARE AND HEALTH OUTCOMES IN THE NEAR ELDERLY

描述(申请人提供)：人们普遍担心，在一个重大的人生转型和健康恶化的时期，接近老年的美国人(55-)在获得医疗保健方面面临越来越多的障碍。这项拟议研究的长期目标是检查近老年人获得护理、使用服务和与健康相关的结果的决定因素。具体目标是确定1)最近重大的人生转变，如健康保险、健康、工作或收入的变化，2)个人当前健康保险计划中的财务和非财务激励，3)医疗保健环境(例如，管理型医疗市场份额，城乡)，以及4)家族史(例如，父母健康和早期生活经历)。审查了妇女和低收入或健康状况不佳的人在获得护理方面的差距，因为这些弱势群体在克服护理障碍方面可能还有额外的困难。这项研究建立在威斯康星州纵向研究(WLS)的优势之上。44年来，WLS一直在跟踪那些 1957年毕业于威斯康星州高中(N=10,317)和随机选择的兄弟姐妹(N=7,638)。收集了有关心理和身体健康、医疗保险、社会经济状况和职业史的数据。WLS项目负责人提议在2002-03年度对在世的毕业生及其兄弟姐妹进行新一轮的电话和邮件调查。该提案通过以下方式扩展WLS：1)在WLS电话和邮件调查中增加有关医疗保险、医疗服务的使用和健康结果的项目；2)通过对医疗保险公司的调查收集有关医疗计划特征的详细信息；3)链接到区域资源文件和InterStudy的环境数据；以及4)将符合条件的兄弟姐妹记录与联邦医疗保险登记和索赔数据联系起来。多水平模型将被用来分离个人、他们的健康计划、医疗保健环境和他们的家族史的影响，以解释在获得护理、服务使用和健康结果方面的差异。这项拟议的研究将为对近老年人的健康和保健体验感兴趣的政策制定者和研究人员提供有价值的信息。

DESCRIPTION (provided by applicant): There are widespread concerns that near-elderly Americans (55-64 years old) face increasing barriers to obtaining health care during a time of significant life transitions and deteriorating health. The long-term objective of the proposed research is to examine determinants of access to care, use of services, and health-related outcomes in the near-elderly. The specific aims are to determine the role of 1) significant recent life transitions such as changes in health insurance, health, work, or income, 2) financial and non-financial incentives in a person's current health insurance plan, 3) the healthcare environment (e.g., managed care market share, rural/urban), and 4) family history (e.g., parental health and early life experiences). Disparities in access to care are examined for women and persons with low income or poor health, as these vulnerable subgroups may have additional difficulties overcoming barriers to care. This study builds on the strengths of the Wisconsin Longitudinal Study (WLS). For 44 years, the WLS has followed men and women who graduated from Wisconsin high schools in 1957 (N=10,317) and a randomly selected sibling (N=7,638). Data were collected on mental and physical health, health insurance, socioeconomic status, and occupational histories. WLS project leaders have proposed a new round of telephone and mail surveys in 2002-03 of the surviving graduates and their siblings. This proposal extends the WLS by 1) adding items on health insurance, access to care, use of health services, and health outcomes to the WLS telephone and mail surveys, 2) collecting detailed information on health plan characteristics through a survey of health insurance companies, 3) linking to environmental data from the Area Resource File and Interstudy, and 4) linking eligible sibling records to Medicare enrollment and claims data. Multilevel modeling will be used to separate the effects of individuals, their health plans, there healthcare environment, and their family history in explaining variation in access to care, use of services, and health outcomes. The proposed research will provide valuable information to policymakers and researchers interested in the health and healthcare experiences of the near-elderly.