title: Medicare-certified home health care: urban-rural differences in utilization.
abstract: BACKGROUND
  Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail.
  
  
  OBJECTIVE
  To examine urban-rural differences in Medicare HHC utilization.
  
  
  METHODS
  The 2002 100% Medicare HHC claims and denominator files were used to estimate use of HHC and to make urban-rural comparisons on the basis of utilization levels within ZIP codes.
  
  
  RESULTS
  Overall, the proportion of Medicare beneficiaries living in areas with little HHC utilization is relatively low. Rural elders, however, are more likely than their urban counterparts to live in such areas. Less than 1% of urban beneficiaries live in ZIP codes with no or low use of HHC, but over 17% of the most rural beneficiaries live in such areas.
  
  
  CONCLUSIONS
  Continued monitoring of rural HHC utilization and access is important, especially as Medicare seeks to evaluate the effectiveness of payment increases to rural home health agencies.
authors.affiliation: University of Minnesota, School of Public Health, Division of Health Policy and Management, Minneapolis, MN 55455, USA.
authors.forename: Lacey
authors.initials: L
authors.lastname: Hartman
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Jarosek
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.forename: Sara
authors.initials: S
authors.lastname: Durham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002568:Certification; D018588:Fee-for-Service Plans; D006297:Health Services Accessibility; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D006278:Medicare / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011445:Prospective Payment System; D012424:Rural Population; D014481:United States; D014505:Urban Population