Socioeconomic disparities in the use of home health services in a medicare managed care population

Health Serv Res. 2004 Oct;39(5):1277-97. doi: 10.1111/j.1475-6773.2004.00290.x.


Objective: To investigate socioeconomic disparities in access to home health visits and durable medical equipment by persons enrolled in two Medicare managed care health plans.

Data sources: A telephone survey of 4,613 Medicare managed care enrollees conducted between April and October of 2000 and linked to administrative claims for a subsequent 12-month period.

Study design: We estimated a series of logistic regression models to determine which socioeconomic factors were related to home health visits and the use of durable medical equipment (DME) among Medicare managed care enrollees.

Principal findings: Controlling for health and demographic differences, Medicare managed care enrollees in the lowest tertile for nonhousing assets had 50 percent greater odds than those in the highest tertile of having one or more home health visits. All else equal, enrollees with less than a high school education had 30 percent lower odds than those who had graduated from high school of using durable medical equipment.

Conclusions: Medicare managed care enrollees of low socioeconomic status do not appear to have reduced access to home health visits; however, use of durable medical equipment is considerably lower for enrollees with less than a high school education. Physicians and therapists working with Medicare managed care enrollees may want to actively target DME prescriptions to those with educational disadvantages.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Durable Medical Equipment / statistics & numerical data*
  • Educational Status
  • Female
  • Health Care Surveys
  • Health Services Accessibility*
  • Home Care Services / statistics & numerical data*
  • Humans
  • Likelihood Functions
  • Logistic Models
  • Male
  • Managed Care Programs*
  • Medicare*
  • Socioeconomic Factors
  • United States