E. Moy et C. Hogan, ACCESS TO NEEDED FOLLOW-UP SERVICES - VARIATIONS AMONG DIFFERENT MEDICARE POPULATIONS, Archives of internal medicine, 153(15), 1993, pp. 1815-1823
Background: We developed a new approach to measuring access to care th
at examines posthospitalization follow-up care. it reveals differences
in receipt of follow-up care among different subsets of the Medicare
population. Methods: Medicare administrative databases from 1986, 1988
, and 1990 were used to construct tree retrospective cohorts. Each coh
ort consisted of patients from a random 1% sample of Medicare benefici
aries admitted with selected conditions that almost always require tim
ely follow-up care. Various ''vulnerable populations'' within these co
horts were defined on the basis of age, sex, race, and other demograph
ic factors. Merged outpatient records were used to determine receipt o
f postdischarge follow-up physician services, follow-up services in ou
tpatient departments, and any follow-up care for these different Medic
are populations. Results: Beneficiaries aged 85 years or older, black
beneficiaries, Medicaid/Qualified Medicare Beneficiaries, residents of
urban core counties, residents of the highest-poverty ZIP codes, and
residents of Health Professional Shortage Areas were less likely to re
ceive follow-up physician services. Beneficiaries aged 85 years or old
er, black beneficiaries, residents of the highest-poverty ZIP codes, a
nd residents of Health Professional Shortage Areas were less likely to
receive any follow-up care. Results: This method identified some Medi
care populations who failed to receive needed follow-up services, sugg
esting problems with access to care. This method may be useful in trac
king changes in access under the new Medicare fee schedule.