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.
Department of Medicine, University of Maryland School of Medicine, Baltimore.
E
E
Moy
C
C
Hogan
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