Objective: To examine the impact of patient, provider, and health care system characteristics on the level of care received by elderly diabetics on Medicare.
Study Design: Data were from the 1996 Medicare Current Beneficiary Survey (MCBS). Health care utilization was obtained from the claims data associated with this sample (physician/supplier, inpatient, outpatient, home health). Six measures recommended by the ADA were used to assess the level of care diabetics were receiving: urinalysis, lipid testing, blood glucose measurement, physician examination, hemoglobin A1C, and creatinine testing. Tests of association were conducted. An ordered probit was conducted to assess the influence of patient, provider, and health care system characteristics on the probability of receiving these services.
Results: Many elderly diabetics were not receiving the recommended levels of care. Some procedures were performed more frequently than others (ordered association). Patient factors that were significant predictors included race (nonwhite), Type 1 diabetes, poorer health, lower income, urban residence, and having a usual source of care. Physician age decreased the probability of receiving these services; board certification and specialty increased the probability. Health care system factors were not significant predictors of receiving a service.
Conclusions: Elderly diabetics are not receiving optimal diabetes care. Examination of the patient, physician, and health care system characteristics simultaneously provides a more comprehensive description of the care provided to this group. Effective dissemination of ADA guidelines in ambulatory care settings can reduce the variation in physician practice patterns and may minimize the long-term complications of diabetes and the associated costs.
Learning Objectives: 1. To articulate and distinguish the factors affecting the care of Medicare beneficiaries with diabetes. 2. To recognize that patient, physician, and health care system factors must be modeled simultaneously
Keywords: Diabetes, Medicare
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.