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Poor familiarity with Medicare system may negatively affect beneficiaries' quality of care, health outcomes, study shows

Wednesday, November 19 2008 | Comments

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What's This? Medicare beneficiaries who report being unfamiliar with the Medicare system are more likely to delay care because of cost and to have multiple emergency department (ED) visits, less prescription drug use, poorer perceived access to care, poorer overall health and a greater reported decline in health from the previous year as compared with beneficiaries who report being familiar with the Medicare system, according to the results of a recently published survey.

The survey, conducted in the fall of 2004, was mailed to a random sample of 5,697 white, black and Hispanic Medicare beneficiaries in geographically diverse metropolitan and nonmetropolitan areas in the United States. The survey measured respondents' familiarity with original Medicare and Medicare Advantage plans, as well as self-reported measures of health status, health care use and perceived access to care. There was a 53 percent response rate, representing 2,997 completed surveys.

Results showed that 32.5 percent of the Medicare beneficiaries reported being unfamiliar or very unfamiliar with their Medicare program. Those who were most likely to report unfamiliarity with the program included Medicare Advantage enrollees and those enrolled in fee-for-service Medicare without supplemental insurance, as well as minority beneficiaries.

Those unfamiliar with Medicare were more likely to delay care because of cost as compared with the respondents who reported being familiar with Medicare (8.7 percent vs. 4.7 percent, respectively), more likely to have multiple ED visits (27.3 percent vs. 26.8 percent) and to use prescription drugs less frequently (12.8 percent vs. 14 percent). The respondents who were unfamiliar or very unfamiliar with Medicare also were less likely to have any physician visits relative to the respondents who reported being familiar with Medicare (14.5 percent vs. 10.5 percent).

Additionally, the respondents who said they were unfamiliar with Medicare were less likely to report their overall health as being excellent or very good as compared with those who reported being familiar with Medicare (25.7 percent vs. 36 percent) and were more likely to report their health as being poor or very poor (13 percent vs. 6.3 percent).

The respondents who were unfamiliar or very unfamiliar with Medicare also were less likely to report an improvement in their health status from the prior year, with 31.2 percent of this group and 22 percent of the respondents who said they were familiar with Medicare reporting that their health had become somewhat worse or much worse.

The unfamiliar-to-Medicare group also reported fair or poor perceived access to care in general (17.1 percent vs. 9.6 percent in the familiar-to-Medicare group), fair/poor lifesaving or urgent care (13.3 percent vs. 9.4 percent) and fair/poor nonurgent or routine care (13 percent vs. 5.4 percent).

"The findings of the current study suggest that limitations in knowledge and familiarity contribute significantly to problems with health care access," the authors stated. "The design and targeting of information campaigns and special programs aimed at increasing knowledge need careful consideration and may be critical for improving the access and quality of care for Medicare beneficiaries," they concluded.

The data were published in the November issue of the Journal of the American Geriatrics Society.

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