Access to needed follow-up services. Variations among different Medicare populations.
BACKGROUND
We developed a new approach to measuring access to care that examines post-hospitalization follow-up care. It reveals differences in receipt of follow-up care among different subsets of the Medicare population.


METHODS
Medicare administrative databases from 1986, 1988, and 1990 were used to construct three retrospective cohorts. Each cohort consisted of patients from a random 1% sample of Medicare beneficiaries admitted with selected conditions that almost always require timely follow-up care. Various "vulnerable populations" within these cohorts were defined on the basis of age, sex, race, and other demographic factors. Merged outpatient records were used to determine receipt of postdischarge follow-up physician services, follow-up services in outpatient departments, and any follow-up care for these different Medicare populations.


RESULTS
Beneficiaries aged 85 years or older, black beneficiaries, Medicaid/Qualified Medicare Beneficiaries, residents of urban core counties, residents of the highest-poverty ZIP codes, and residents of Health Professional Shortage Areas were less likely to receive follow-up physician services. Beneficiaries aged 85 years or older, black beneficiaries, residents of the highest-poverty ZIP codes, and residents of Health Professional Shortage Areas were less likely to receive any follow-up care.


CONCLUSIONS
This method identified some Medicare populations who failed to receive needed follow-up services, suggesting problems with access to care. This method may be useful in tracking changes in access under the new Medicare fee schedule.
Moy
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E
Department of Medicine, University of Maryland School of Medicine, Baltimore.
Hogan
C
C
D000359:Aftercare / Q000191:economics / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States