title: Do disabled elderly Medicare beneficiaries with major depression make less use of a consumer-directed home care voucher benefit?
abstract: Older adults with major depression may underutilize consumer-directed long-term care. Systematic underutilization would create disparities in outcomes, undermining program effectiveness. The Medicare Primary and Consumer-Directed Care Demonstration included a consumer-directed indemnity benefit that paid for goods and services not financed by traditional Medicare. Overall and for most categories of goods and services there was little difference in use and expenditures between those with and without major depression. However, among those using the benefit to hire in-home workers, arguably the most important consumer-directed purchase, average spending for workers was about 30% lower for depressed persons. While our findings are generally reassuring for public policy, future research is needed to verify that major depression is associated with less spending on in-home workers.
authors.affiliation: a Departments of Public Health Sciences and Psychiatry , University of Rochester Rochester , New York , USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Friedman
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Wamsley
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
mesh_terms: D000328:Adult; D000368:Aged; D003256:Community Participation / Q000191:economics; D003865:Major Depressive Disorder; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005102:Health Expenditures; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000191:economics; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: aged; consumer-directed care; home care; major depression; personal care; self-directed care