Access to care and functional status change among aged Medicare beneficiaries.
OBJECTIVE
This study examined whether the extra-individual factors of better access to care and supplementary health insurance coverage can prevent, delay, or reverse transitions from functional independence to disability over time.


METHODS
Six years of the Medicare Current Beneficiary Survey were pooled, yielding 40,793 transition periods for community residents aged 66 or older. Multinomial logit models of transitions among functional states were estimated, with functional improvement, functional decline, and mortality as outcomes.


RESULTS
Insurance coverage and better access to care increased survival chances and reduced the odds of transitions from independence to disability by roughly 30%. Access and supplementary insurance did not appear to affect transitions from less disabled to more disabled states or affect functional improvement.


CONCLUSIONS
The findings support the hypothesized role of extra-individual environmental factors in Verbrugge and Jette's conceptual scheme of the disablement process. Access to care is suggested to make the most difference in delaying or slowing down functional decline among functionally independent elderly persons. Transitions from less severe to more severe states of disability or to death appear to be influenced more by the natural course of chronic diseases, underlying health status, and medical instability.
Gerontology Institute, University of Massachusetts, Boston 02125-3393, USA. frank.porell@umb.edu
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D000203:Activities of Daily Living / Q000145:classification; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D004185:Disability Evaluation; D005260:Female; D006297:Health Services Accessibility; D006299:Health Services for the Aged / Q000600:supply & distribution*; D006801:Humans; D019458:Insurance Coverage; D017054:Insurance, Medigap; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States