title: Using population-based data to examine preventive services by disability type among dually eligible (Medicare/Medicaid) adults.
abstract: BACKGROUND
  Individuals dually eligible for Medicaid and Medicare constitute a small percentage of these program's populations but account for a disproportionately large percent of their total costs. While much work has examined high expenditures, little is known about their health and details of their health care utilization.
  
  
  OBJECTIVE
  Utilize an important public health surveillance tool to better understand preventive service use among the dual eligible population.
  
  
  METHODS
  This study involved descriptive and regression analyses of dual eligibles in the Medical Expenditure Panel Survey data from pooled alternate years 2000-2008. We classified the sample into 4 mutually exclusive groups: cognitive limitations, physical disabilities, double diagnosis (cognitive limitations and physical disability), or neither cognitive limitations nor physical disability.
  
  
  RESULTS
  For most groups, age was significantly associated with preventive services, though direction varies. Older age was linked to greater receipt of flu shots while younger age was associated with greater receipt of Pap tests, mammograms and dental services. Black women in all groups (except cognitive limitations) had an increased likelihood of receiving a Pap test and a mammogram.
  
  
  CONCLUSIONS
  A subset of dual eligibles drives the majority of expenditures. People with physical disabilities, regardless of whether they also have a cognitive limitation, are among the highest costing and sickest of our non-institutionalized dual eligible population. Efforts to understand and address the challenges faced by women with physical disabilities in accessing Pap tests or mammograms may be helpful in improving the overall health status for this disability group, but also for all dual eligibles.
authors.affiliation: University of Kansas, Research and Training Center on Independent Living, Lawrence, KS 66045, USA. reichard@ku.edu
authors.forename: Amanda
authors.initials: A
authors.lastname: Reichard
authors.forename: Michael H
authors.initials: MH
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D003072:Cognition Disorders / Q000150:complications / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D003729:Dental Care; D003954:Diagnostic Services / Q000191:economics / Q000706:statistics & numerical data; D006233:Persons with Disabilities; D004608:Eligibility Determination; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States; D014611:Vaccination; D055815:Young Adult; D001741:Black or African American