Access to care and functional status change among aged Medicare beneficiaries

Objectives, This study examined whether the extra-individual factors of bet ter access to care and supplementary health insurance coverage can prevent, delay, or reverse transitions from functional independence to disability o ver time. Methods, Six years of the Medicare Current Beneficiary Survey were pooled. yielding 40.793 transition periods for community residents aged 66 or older . Multinomial logit models of transitions among functional stares were esti mated, with Functional improvement. functional decline, and mortality as ou tcomes. Results. insurance coverage and better access to care increased survival ch ances and reduced the odds of transitions from independence to disability b y roughly 30%. Access acid supplementary insurance did not appear to affect transitions From less disabled to more disabled states or affect functiona l improvement. Discussion. The findings support the hypothesized role of extra-individual environmental factors in Verbrugge and Jetts's conceptual scheme of the dis ablement process. Access to care is suggested to make the most difference i n delaying or slowing down functional decline among functionally independen t elderly persons. Transitions From less severe to more severe states of di sability or to death appear to be influenced more by the natural course of chronic diseases. underlying health status, and medical instability.