The Aging Population in the Twenty-First Century Statistics for Health Policy (1988) / Chapter Skim
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9 Health Services Utilization
9 Health Services Utilization
Pages 178-201
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From page 178... ...
Among these are public policies that specify the types of services and providers covered by public funds, cost-sharing provisions, the supply of alternative sources and types of care; living arrangements and access to informal care; the availability of adequate numbers of trained personnel; advances or changes in health care technology and delivery systems; and the attitudes and values of potential recipients and providers of care. The issues involved are shaped largely by public policies dealt with previously in the discussions of long-term care in Chapter 7 and the financing of health care services for the elderly in Chapter 8.
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From page 179... ...
To what extent are advances in diagnostic and therapeutic health care technology reaching the elderly; how are they ad fecting utilization of health services subsequent to treatment; what is the role of government in determining appropriate access of the elderly to health care technology established as cost-effective? How are changes in the structure of health care systems and reimbursement arrangements, e.g., capitation payments to HMOs and preferred provider organizations influencing the patterns of health care utilization; how effective are these changes in meeting health care needs of the elderly?
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From page 180... ...
. This information is subject to a variety of interpretations, but self-assessed or perceived health status is associated with the use of health care services as measured, for instance, by rates of physician utilization (Crazier, 1985; Waldo and Lazenby, 1984~.
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From page 181... ...
Much of the increase in service utilization of hospitals, skilled and intermediate care nursing facilities, home health care, and physicians' services, for instance, has been attributed to previously unmet needs (Rabin, 1985~. Changes in coverage provisions and reimbursement rates, for both the federal Medicare program and the federaI-state Medicaid program, are likely to affect future utilization patterns, as well as the providers of care, as they have in the past (see Chapter 8~.
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From page 182... ...
The chronic care needs of the moderately impaired elderly assistance with activities of daily living or instrumental activities of daily living, for examplein contrast to their strictly medical care needs, can be met in a variety of settings. These settings include intermediate care nursing facilities, retirement communities, adult day care centers or programs, or the home with the assistance of family members or with communityprovided services such as meals-on-wheels and visiting nurses.
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From page 183... ...
As the population ages, successive cohorts of potential informal caregivers, such as spouses or adult children of ill or impaired elderly people, will be older as well and possibly less able to care for their elderly relatives because of their own health limitations. In addition, families are having fewer children and, as discussed in Chapter 2, the number of elderly women living alone is increasing rapidly.
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From page 184... ...
Attitudes and Values of Potential Recipients and Providers of Care Attitudes regarding formal caregivers and the perceived value of formal health care services by older adults affect health care utilization rates. Of major importance are perceptions and attitudes concerning the nature of an "illness," which may be very different from the medically defined "disease" diagnosed within the health care setting.
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From page 185... ...
Information on health services utilization by the elderly is generated by three types of federal data collection activities: providerbased surveys, general population surveys, and administrative records maintained by federal agencies. Provider-based surveys generate information about health services utilization by surveying samples of providers of care, such as hospitals, physicians, and nursing homes.
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From page 186... ...
The study defines health personnel broadly to include not only the usual professionals who deal with and render care to the elderly in both institutional and noninstitutional settings (e.g., physicians, registered nurses, social workers) , but also nursing home and hospital administrators, specialized geriatricians, all varieties of acute and Tong-term care nurse and allied personnel below the bachelor's level (such as I`PNs and aides)
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From page 187... ...
encourages federal agencies to give further attention to mechanisms by which such information can be generated. Measuring the Effects of Changes In the Organization, Provision, and Coverage of Health Care Services Changes in Provider Characteristics Changes in the organization and provision of health care and related services, as discussed more fully in Chapter 5, are having and will continue to have a considerable impact on the service utilization patterns not only of the general population but also of the elderly.
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From page 188... ...
. Recommendation 9.2: The panel recommends that the National Ambulatory Medical Care Survey sampling frame be expanded to include physicians practicing in federal hospitals, hospital outpatient clinics, surgi-centers, and other alternative care centers.
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From page 189... ...
National Health Care Surrey The National Center for Health Statistics plans to develop an integrated National Health Care Survey by merging over tune its four provider-based surveys: the National Hospital Discharge Survey, the National Nursing Home Survey (described in Chapter 7) , the National Ambulatory Medical Care Survey (described earlier in this chapter)
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From page 190... ...
The design would focus initially on the hospital, next on modification of the NAMCS beginning in 1989, the long-term care elements in 1991, and the NMFT in time to provide a frame for the 1991 long-term care survey. (The panel's Recommendation 7.4 for a three-year cycle for the National Nursing Home Survey is somewhat at variance with this plan.)
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From page 191... ...
The Hispanic Health and Nutrition Examination Survey (HHANES) , administered from 1982 to 1984 to a sample of Hispanics, included both a dental examination and interview items pertaining not only to perception of dental health, but also to utilization of dental services and barriers to dental care.
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From page 192... ...
Facilities other than nursing homes that provide rehabilitative care as their primary focus are not currently included in the National Master Facility Inventory, which serves as the sampling frame for the National Nursing Home Survey. In Chapter 7 the pane!
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From page 193... ...
Recommendation 9.5: The pane] recommends that the National Center for Health Statistics explore with the National Institute of Mental Health means by which the use of mental health services by older adults, whether provided by specialty or general health care practitioners, can be disaggregated from their use of other health services in national surveys, both population- and provider-based.
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From page 194... ...
. The pane} design of the current National Medical Expenditure Survey will permit analysis of changes in utilization and expenditure patterns over the course of a year.
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From page 195... ...
linkage with Medicare records be performed on a routine basis for persons age 65 and over who are respondents to population surveys that collect health data and (b) the Health Care Financing Administration and the National Center for Health Statistics explore linking the continuous National Health Interview Survey with the Medicare Automated Data Retrieval System, when the latter becomes operational.
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From page 196... ...
Since the poor tend to be sicker than others, the higher medical care use rates among the poor do not necessarily indicate that they get more care given similar health status. An indicator of this is that poor persons of all ages, including the elderly, who report their health as fair or poor have significantly fewer physician visits than their counterparts in higher income groups (Kleinman et al., 1981~.
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From page 197... ...
The Long-term Care Survey asks impaired elderly people directly about unmet needs for health care within the past month and why medical assistance has not been sought in the presence of unmet need. Perhaps the most comprehensive set of access questions to appear on a federal survey is found in the National Medical Expenditure Survey.
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From page 198... ...
This is particularly true for the continuous National Health Interview Survey, the periodic expenditure survey, the latest version of which is the National Medical Expenditure Survey, and the Longitudinal Study on Aging. Further, such population-based surveys can determine access problems of potentially vulnerable or high-risk segments of the population, such as the poor, the uninsured, specific racial and ethnic minorities, and the oldest-old.
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From page 199... ...
The Veterans Administration is in a position to develop health-related information for the subgroup of veterans that utilize VA services. However, for a more complete understanding of patterns of care, health status, and access problems among veterans, it is necessary to turn to general population surveys.
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From page 200... ...
Recommendation 9.9: The panel recommends that the National Center for Health Statistics and the National Center for Health Services Research and Health Care Technology take action to strengthen information regarding health services utilization and access to care among the rural population, by designing population-based surveys to include sufficiently large samples of the rural elderly population to provide suitably precise estimates for analytic evaluation of this population. While the pane]
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From page 201... ...
Ibese two Judas oF tar unlace opportunlt~s to document the bet services utOlz~tlon patterns of the rural elderk ~ these locatlons. Abe panel urges tab these rural elderly panes be Ballad on ~ lon~tudloal bails.
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