Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112015

Lacey K. Hartman, MPP¹, Beth Virnig, PhD, MPH², and Sara B. Durham, MS¹. (1) Health Services Research and Policy, University of Minnesota, School of Public Health, 420 Delaware St. SE, A364 Mayo Memorial Building, Minneapolis, MN 55455, 612-626-5003, hartm042@umn.edu, (2) Division of health services research and policy, University of Minnesota, 420 Delaware Street, S.E., Mayo mail code 97, Minneapolis, MN 55455

Understanding access to home based services such as home health care is increasingly important as Medicare shifts its coverage policies away from a focus on inpatient care. We estimated and mapped Medicare certified home health care service by ZIP code with an algorithm that considers the percentage of beneficiaries in a given ZIP code using home health care and the size of the beneficiary population. While the majority of Medicare enrollees live in ZIP codes served by home health, nearly a million beneficiaries live in ZIP codes that are unserved or underserved. Unserved ZIP codes tend to be concentrated in the rural areas of western and Midwestern states. For example, while we estimate that nearly all of the ZIP codes in an urban state such as Delaware are served by home health, nearly 30% of the ZIP codes and 9% of the enrollees in the heavily rural state of South Dakota are unserved. Unserved ZIP codes tend to be low population and cover large geographic areas. In South Dakota, over 60% of enrollees unserved by home health live in frontier or “very rural” ZIP codes. Such areas are also traditionally underserved by inpatient services, making lack of access even more troubling. The lack of service likely reflects the economic challenges to agencies attempting to remain solvent while serving small and widely-dispersed populations. We will present a national map of the availability of home health service, characterize the unserved and underserved areas, and discuss the policy implications of these findings.

Learning Objectives:

• Participants will understand the association between geography and access to home based services.
• Participants will become familiar with the policy implications of providing home based care in sparsely populated areas.

Keywords: Access to Health Care, Home Based

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.