Special Article on Dually Eligible
Research Paper
Using population-based data to examine preventive services by disability type among dually eligible (Medicare/Medicaid) adults

https://doi.org/10.1016/j.dhjo.2012.12.001Get rights and content

Abstract

Background

Individuals dually eligible for Medicaid and Medicare constitute a small percentage of these program's populations but account for a disproportionately large percent of their total costs. While much work has examined high expenditures, little is known about their health and details of their health care utilization.

Objective/hypothesis

Utilize an important public health surveillance tool to better understand preventive service use among the dual eligible population.

Methods

This study involved descriptive and regression analyses of dual eligibles in the Medical Expenditure Panel Survey data from pooled alternate years 2000–2008. We classified the sample into 4 mutually exclusive groups: cognitive limitations, physical disabilities, double diagnosis (cognitive limitations and physical disability), or neither cognitive limitations nor physical disability.

Results

For most groups, age was significantly associated with preventive services, though direction varies. Older age was linked to greater receipt of flu shots while younger age was associated with greater receipt of Pap tests, mammograms and dental services. Black women in all groups (except cognitive limitations) had an increased likelihood of receiving a Pap test and a mammogram.

Conclusions

A subset of dual eligibles drives the majority of expenditures. People with physical disabilities, regardless of whether they also have a cognitive limitation, are among the highest costing and sickest of our non-institutionalized dual eligible population. Efforts to understand and address the challenges faced by women with physical disabilities in accessing Pap tests or mammograms may be helpful in improving the overall health status for this disability group, but also for all dual eligibles.

Section snippets

Methods

Non-institutionalized adults age 18+ were identified in the MEPS from pooled alternate years 2000–2008. In order to be identified as a dual eligible, Medicare and Medicaid eligibility had to be concurrent during the year in which they were surveyed, leading to an unweighted 5-year sample of 3514 (weighted 5-year sample = 4,428,630). Pooling data across years allowed us to achieve a sufficient sample size for the disability subgroups among those who are dually eligible for Medicaid and Medicare.

Results

Overall in our weighted sample, 49.5% of the people identified as dual eligibles either had only a cognitive limitation (4.4%), only a physical disability (32.3%) or both (“double diagnosis,” 12.8%), leaving 51.5% either without a disability or with a disability that did not fit into one or the other of these two categories. Medicare identifies disability only for people who are under 65, an estimated 41% of all dual eligibles.41 Our data suggest that there are a substantial number of dual

Discussion

The dual eligible population has become the focus of much state and federal policy recently as our understanding of their impact on our health care system has improved.11, 40, 41, 43, 44, 45, 46 Our study builds upon earlier work which explored disability prevalence within the dual eligible population, extending analyses to associations within and between categories of disabilities. We paid particular attention toward understanding factors influencing receipt of preventive services while also

Acknowledgment

The authors gratefully acknowledge statistical support was provided by Ms. Kandace Fleming and the extensive editorial support provided by Ms. Mallory Murphy of the University of Kansas in the development of this manuscript.

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  • Cited by (0)

    We have no conflicts of interest to report. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

    This work was funded, in part under two Research and Training Center grants from the National Institute on Disability and Rehabilitation Research, award numbers H133B060018 and H133B110006.

    We presented the content at an oral presentation at Academy Health Disability Research Interest Group meeting, Orlando, FL, June 23, 2012.

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