ACCESS TO NEEDED FOLLOW-UP SERVICES - VARIATIONS AMONG DIFFERENT MEDICARE POPULATIONS

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.