Disability Stages and Trouble Getting Needed Health Care Among Medicare Beneficiaries.
Heather F McClintock, Jibby E Kurichi, Pui L Kwong and 6 others
PMID 27754997WHAT IT FOUND
Medicare beneficiaries with greater activity limitations reported significantly more trouble accessing needed health care.
Financial barriers were the most common reason overall, while transportation and home health care difficulties were especially cited by those with more severe physical limitations.
Key findings
01Compared to beneficiaries with no limitations, those with mild to complete ADL and IADL limitations were more likely to report trouble accessing needed health care.
02Among beneficiaries reporting trouble getting care, the most common reasons were high costs, not having enough money, and services or supplies not being covered.
03Persons at higher activity limitation stages were significantly more likely to report difficulties with transportation and problems getting home health care.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study relied on self-reports and proxy responses, which may be affected by recall bias, social desirability bias, and inaccuracies in proxy reporting. The findings may not be generalizable to all Medicare beneficiaries or other populations, as the sample was limited to community-living individuals and specific exclusion criteria were applied. The cross-sectional nature of the analysis limits the ability to infer causality between activity limitations and access barriers. Potential model misspecification exists if relevant variables were not incorporated, although the authors adjusted for many known confounders.
Declared interests
The authors declared no financial or other conflicts of interest. The study was supported by the Patient-Centered Outcomes Research Institute (PCORI) and the National Institutes of Health (NIH).
The easy way to misread this
Do not assume that financial barriers are the only issue for patients with physical limitations. While cost was the most common reason overall, transportation and home health care access became significantly more problematic as physical disability severity increased. A patient's inability to attend therapy may be due to logistical barriers rather than just cost.