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The influence of health policy on ac...

University of the Sciences in Philadelphia.

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The influence of health policy on access to outpatient rehabilitation services by Medicare patients with musculoskeletal conditions.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	The influence of health policy on access to outpatient rehabilitation services by Medicare patients with musculoskeletal conditions./
Author:	Johnson, Michael P.
Description:	211 p.
Notes:	Source: Dissertation Abstracts International, Volume: 70-02, Section: B, page: 0974.
Contained By:	Dissertation Abstracts International70-02B.
Subject:	Health Sciences, Health Care Management. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoeng/servlet/advanced?query=3346502
ISBN:	9781109012729

The influence of health policy on access to outpatient rehabilitation services by Medicare patients with musculoskeletal conditions.
Johnson, Michael P.

The influence of health policy on access to outpatient rehabilitation services by Medicare patients with musculoskeletal conditions. - 211 p.

Source: Dissertation Abstracts International, Volume: 70-02, Section: B, page: 0974.

Thesis (Ph.D.)--University of the Sciences in Philadelphia, 2008.

Purpose. Medicare (MCR) payments for Outpatient Rehabilitation Services (OPRS) were targeted in the Balanced Budget Act of 1997 (BBA). An Arbitrary Cap (

ISBN: 9781109012729Subjects--Topical Terms:

1017922
Health Sciences, Health Care Management.

The influence of health policy on access to outpatient rehabilitation services by Medicare patients with musculoskeletal conditions.
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020 $a 9781109012729
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100 1 $a Johnson, Michael P. $3 1025344
245 1 4 $a The influence of health policy on access to outpatient rehabilitation services by Medicare patients with musculoskeletal conditions.
300 $a 211 p.
500 $a Source: Dissertation Abstracts International, Volume: 70-02, Section: B, page: 0974.
502 $a Thesis (Ph.D.)--University of the Sciences in Philadelphia, 2008.
520 $a Purpose. Medicare (MCR) payments for Outpatient Rehabilitation Services (OPRS) were targeted in the Balanced Budget Act of 1997 (BBA). An Arbitrary Cap ( $1 ,500) and the Medicare Physician Fee Schedule were applied to payment for OPRS in 1999. Previous studies suggest access to rehabilitation services were impacted, but included limited population demographic and health related data. This study examined the impact of BBA provisions on MCR patients with musculoskeletal (MSK) conditions receiving OPRS from 1997 to 2000. Subjects. Subjects were 65 years and older, with MCR insurance and a primary MSK diagnosis (ICD-9-CM codes). Final weighted samples by year ranged from N=424,200 to 525,591. Methods. Data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) were used. Descriptive and inferential analyses (SAS, SUDAAN) examined population demographic and health related characteristics by year. Results. MCR beneficiaries accessing OPRS comprised a small portion of the population (6%), yet tended to be white (95%) and more educated (77%). No differences in access to OPRS were observed between 1997 and 2000, however, multivariate logistic regression models revealed disparities in access existed among the MCR population in 1999 and 2000. In 1999, patients with lower education levels (< 12 years; odds ratio [OR]=0.52; 95% confidence interval [CI], 0.27-0.92) and lower to middle income (OR=0.50; OR=0.36, respectively) were less likely to receive OPRS. In 2000, patients with a high school education or less (OR=0.54; OR=0.40, respectively) and males (OR=0.63; 95% CI, 0.37-1.07) were less likely to receive OPRS, while whites (OR=2.40; 95% CI, 0.86-6.69), and patients aged 70-79 years (OR=1.67; 95% CI, 1.01-2.77) were more likely to receive OPRS. Discussion . Specific subgroups of MCR patients with MSK conditions experienced greater limitations in access to OPRS in 1999 and 2000. This suggests that accessing needed care requires more than simply having health insurance. People with a lower socioeconomic status tend to be in poorer health due, in part, to disparities resulting from an unequal distribution of education and income. Future health policy decisions impacting MCR beneficiaries need to consider efforts, such as health education/promotion, to assist beneficiaries in effectively addressing their health needs.
590 $a School code: 1379.
650 4 $a Health Sciences, Health Care Management. $3 1017922
650 4 $a Health Sciences, Rehabilitation and Therapy. $3 1017926
690 $a 0382
690 $a 0769
710 2 $a University of the Sciences in Philadelphia. $3 1017850
773 0 $t Dissertation Abstracts International $g 70-02B.
790 $a 1379
791 $a Ph.D.
792 $a 2008
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoeng/servlet/advanced?query=3346502