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Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.

ABSTRACT: To examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities.Secondary analysis of Medical Expenditure Panel Survey (MEPS) data from 2002 to 2008.We conducted cross-sectional logistic regression analyses comparing people with different types of disabilities on health insurance status and type; presence of a usual source of health care; delayed or forgone care; and receipt of dental checkups and cancer screening.We pooled annualized MEPS data files across years. Our analytic sample consisted of adults (18-64 years) with physical, sensory, or cognitive disabilities and nonmissing data for all variables of interest.Individuals with hearing impairment had better health care access and receipt than people with other disability types. People with multiple types of limitations were especially likely to have health care access problems and unmet health care needs.There are differences in health care access and receipt of preventive care depending on what type of disability people have. More in-depth research is needed to identify specific causes of these disparities and assess interventions to address health care barriers for particular disability groups.

SUBMITTER: Horner-Johnson W

PROVIDER: S-EPMC4254135 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.

Horner-Johnson Willi W Dobbertin Konrad K Lee Jae Chul JC Andresen Elena M EM

Health services research 20140624 6

<h4>Objective</h4>To examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities.<h4>Data source</h4>Secondary analysis of Medical Expenditure Panel Survey (MEPS) data from 2002 to 2008.<h4>Study design</h4>We conducted cross-sectional logistic regression analyses comparing people with different types of disabilities on health insurance status and type; presence of a usual source of health care; delayed ...[more]

PMID: 24962662

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Project description:BackgroundIndividuals with limited English proficiency (LEP) have worse healthcare access and report lower quality of care compared to individuals who are proficient in English. Policy efforts to improve patient-provider communication for LEP individuals have been going on for decades but linguistic disparities persist.ObjectiveTo describe trends in patient-provider communication by limited English proficiency (LEP) from 2006 to 2015.DesignWe estimated interrupted time series models for three measures of patient-provider communication, testing for differences in both means (intercepts) and trends (slopes) before and after 2010 and differences in differences by English proficiency.ParticipantsA nationally representative sample of the US non-institutionalized population with at least one office-based medical visit from the 2006-2015 Medical Expenditure Panel Survey (N = 27,001).Main measuresPatient-provider communication is measured with three variables indicating whether individuals reported that their providers always explained things in a way that was easy to understand, showed respect for what they had to say, and listened carefully.Key resultsAlthough patient-provider communication improved for all groups over the study period, before 2010, it was getting worse among LEP individuals and disparities in patient-provider communication were widening. After 2010, patient-provider communication improved for LEP individuals and language disparities by English proficiency either narrowed or remained the same. For example, between 2006 and 2010, the percent of LEP individuals reporting that their provider explained things clearly declined by, on average, 1.4 percentage points per year (p value = 0.102); after 2010, it increased by 3.0 percentage points per year (p value = 0.003).ConclusionsOur study sheds light on trends in patient-provider communication before and after 2010, a year that marked substantial efforts to reform the US healthcare system. Though patient-provider communication among LEP individuals has improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.

Project description:BackgroundA comprehensive picture of how the US population engages in specialty care use is lacking, even though redesign models focused on specialty care are becoming more popular.ObjectiveTo describe the type of provider, primary care or specialist, most often seen by individuals, to test associations between type of provider most often seen and insurance coverage, and to test associations between the number of generalist and specialist visits and insurance coverage.DesignCross-sectional analysis of 2013-2016 Medicaid Expenditure Panel Survey. Logistic and negative binomial models were used in multivariate regression modeling.ParticipantsDepending on the analysis, the study samples include between 71,402 and 79,518 US residents.Main measuresIndividuals' provider type most often seen, primary care visits, and specialist visits were reported.Key resultsMore than half of the sample (55%) predominantly visited primary care providers (or generalists), and 36% predominantly visited specialists. Among individuals primarily visiting generalists, 80% visited only one type of primary care provider, and 24% also visited one or more specialists. Among individuals primarily visiting specialists, 48% visited only one type of specialist, and 47% did not visit any generalists in the year. Among Medicare enrollees, 50% predominantly visited specialists, and 40% predominantly visited generalists. Medicare enrollment was associated with greater odds of predominantly visiting specialists (p < 0.05), and Medicare-Medicaid enrollment and having no insurance were associated with lower odds of predominantly visiting specialists (p < 0.05). Medicare enrollment was associated with 13% more generalist visits and 35% more specialist visits, and Medicare-Medicaid enrollment was associated with 38% more generalist visits and 15% more specialist visits (all p < 0.05).ConclusionsGiven the overall frequency of specialty care use and the reliance on multiple specialists in any given year, particularly among Medicare enrollees, public payers are uniquely positioned to promote specialty care redesign and champion improved coordination between specialists.

Dataset Information

Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.

Publications

Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.

Similar Datasets

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