title: Disability Stages and Trouble Getting Needed Health Care Among Medicare Beneficiaries.
abstract: OBJECTIVE
  The aim of this study was to examine whether activity limitation stages were associated with patient-reported trouble getting needed health care among Medicare beneficiaries.
  
  
  METHODS
  This was a population-based study (n = 35,912) of Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey for years 2001-2010. Beneficiaries were classified into an activity limitation stage from 0 (no limitation) to IV (complete) derived from self-reported or proxy-reported difficulty performing activities of daily living and instrumental activities of daily living. Beneficiaries reported whether they had trouble getting health care in the subsequent year. A multivariable logistic regression model examined the association between activity limitation stages and trouble getting needed care.
  
  
  RESULTS
  Compared with beneficiaries with no limitations (activities of daily living stage 0), the adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for stage I (mild) to stage IV (complete) for trouble getting needed health care ranged from OR = 1.53 (95% CI, 1.32-1.76) to OR = 2.86 (95% CI, 1.97-4.14). High costs (31.7%), not having enough money (31.2%), and supplies/services not covered (24.2%) were the most common reasons for reporting trouble getting needed health care.
  
  
  CONCLUSIONS
  Medicare beneficiaries at higher stages of activity limitations reported trouble getting needed health care, which was commonly attributed to financial barriers.
authors.affiliation: From the Department of Community and Global Public Health, College of Health Sciences, Arcadia University, Glen Mills, Pennsylvania (HFM); Department of Family Medicine and Community Health (JEK, PLK, LN, HRB), Center for Clinical Epidemiology and Biostatistics (DX, SH, HRB), and Geriatric Psychiatry Section of the Department of Psychiatry (JES), Perelman School of Medicine, University of Pennsylvania; VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center (JES), Philadelphia, Pennsylvania; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (LEP); and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (SH).
authors.forename: Heather F
authors.initials: HF
authors.lastname: McClintock
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: Pui L
authors.initials: PL
authors.lastname: Kwong
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
authors.forename: Sean
authors.initials: S
authors.lastname: Hennessey
authors.forename: Ling
authors.initials: L
authors.lastname: Na
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D006278:Medicare; D014481:United States