The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67471

Hongdao Meng, MPH¹, Dana B. Mukamel, PhD², Bruce Friedman, PhD¹, Gerald M. Eggert, PhD³, and Brenda Wamsley, MSW⁴. (1) Department of Community and Preventive Medicine, University of Rochester, Box 644, Rochester, NY 14642, 585-248-8770, hongdao_meng@urmc.rochester.edu, (2) Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (3) Executive Director, Monroe County Long Term Care Program, Inc./ACCESS, 349 West Commercial Street, Suite 2250, East Rochester, NY 14445, (4) Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101

Research on the effect of price or information on home health care use has been sparse. This study tested the hypotheses that a consumer-directed voucher (price effect) intervention would increase home care use, while a health promotion nurse (information effect) intervention would reduce home care use among disabled elderly Medicare beneficiaries. We used data on 1,441 elderly Medicare beneficiaries collected by a CMS-funded randomized controlled trial with four arms: control, home health voucher, health promotion nurse and the combination of voucher and nurse. Participants were interviewed at enrollment into the study and one year follow-up about their socioeconomic/demographic characteristics and functional status. They also completed a weekly itemized journal about their health services utilization. We used descriptive statistics to describe the characteristics of the participants and bi-variate probit models to predict the joint probability of having any skilled and non-skilled home care use. The average participant was 80 years old, scored 5.8 and 7.5 on 12-point ADL/IADL impairment scales. Participants in the four groups were similar on most of the baseline characteristics. 55% participants had used some skilled home care (physician/nurse practitioner/physician assistant/social worker/therapist home visit), 64% had used some non-skilled home care (home health aide/personal care aide/companion care/respite care). We found a price effect (p<.001) but no information effect (p=0.64) on the use of non-skilled home care. Having the voucher benefit increases the probability of using any non-skilled home care by 44%. We did not find any price or information effect on the use of skilled home care.

Learning Objectives:

• At the conclusion of the session, the participant in this session will be able to:
• 1. Describe the characteristics of socio-demographic, health status, and home health services use among a group of high-risk elderly Medicare beneficiaries.
• 2. Evaluate the effect of price and information on home health use.
• 3. Identify factors associated with skilled/non-skilled home health use.

Keywords: Community Programs, Health Care Utilization

Presenting author's disclosure statement:
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.