INTRODUCTION Many preventive services are underutilized by means of elderly persons in the United States.

INTRODUCTION

Many preventive services are underutilized by means of elderly persons in the United States, despite evidence of their effectiveness (Amonkar et al., 1999; Blustein, 1995; Fox et al., 2001; Gornick, Egger and Riley, 2004; Javitt et al., 1994; Kruspe et al., 2003; Mandelblatt and Phillips, 1996; Picone et al., 2004) and Medicare coverage for them. A report by way of the U.S. Government Accountability Office (2003) institute that nearly 90 percent of Medicare beneficiaries visited a physician at least one time a year, and on average made six visits a year. Despite this number of contacts, many beneficiaries have not had the sated range of recommended, Medicare-covered preventive services.

The literature is clear that expanding insurance coverage can lead to an increase in the use of preventive services. leave for example, to articles on Coleman and O'Sullivan (2001), Henderson and Schenck (2001) and Keleher and Stellman (2000) addressing mammography; an article according to Etzioni et al. (2002) addressing the use of prostate specific antigen (PSA) testing, and a meditation by Morrisey et al. (1995) in succession office-based preventive services. However, it is also clear that expanded coverage, through itself, will not result in optimal use of preventive services (Finison et al., 1999; Keleher and Stellman, 2000; and Fox and Roetzheim, 1994)

The objective of this meditation was to identify factors that predict the use of clinical preventive services among Medicare beneficiaries. The proceeds may help policymakers, health plan administrators, physicians, and others identify stairs to enhance the appropriate use of these services among Medicare beneficiaries.

Data Source and consideration Design

Retrospective analyses were manner of lifeed using MCBS for 2001. First, we estimated the percentage of Medicare beneficiaries who had depressed (less than five), medium (five or six), or high (seven) numbers of clinical preventive services that were measured in the 2001 MCB for a 12-month recall period. For all beneficiaries, these services included pneumococcal vaccination, influenza vaccination, glaucoma screening, cholesterol screening, and house pressure testing. For females we also investigated the use of mammography and Pap smear, and for males, digital rectal exams and PSA proofs were considered. Next, with multinomial logistic regression analyses, we estimated the relationship between utilization of these services and: socioeconomic factors; health plan type; health status; underlying health risks; and ability to take care of one's daily distresss The descriptive and regression analyses adjusted for the compages sampling design used for the MCB inferences are nationally representative for the reflection year.

Sample

The analytic sample (n = 11158) included MCB respondent who were non-institutionalized Medicare beneficiaries living in the community. chiefly (51 percent) were age 65-74 Another 38 percent were age 75-84 and about 11 percent were age 85 or throughout About 58 percent were female, 8 percent were Black, and 10 percent were Hispanic. About 12 percent were still busyed 50 percent were high educate graduates, and 59 percent had incomes les than $25000 About 9 percent were dually enlisted in Medicare and Medicaid. About 21 percent were Medicare+Choice (M+C) members. About 9 percent had no children, and 32 percent lived alone.

Methods

The 2001 MCB data provided information in succession several variables expected to influence preventive services utilization. The socioeconomic factors included in this studious mood measured age, sex, race, marital status, occupation status, income, education, number of living children, whether the respondent lived alone, place of residence, and the availability of personal care services.

With regard to age, we anticipateed lower clinical preventive services use among older patients. Blustein and Weiss (1998) Ives et al. (1996) and Mayer-Oakes et al. (1996) construct that mammography use was lower for older patients, especially among those through the whole extent of age 75. Younger females also appear to beed more likely to have a Pap smear (Ives et al., 1996) a certain number of have argued that screening rates for prostate cancer should be lower for those age 70 or above because screening often finds asymptomatic disease for which there is no useful treatment (Potosky et al., 1995) or leads to treatments that add solely a few days of life for the typical somewhat advanced in life patient (Coley et al., 1997)

With regard to sex females are oftentimes observed to be greater users of health care, including preventive screenings (Sindelar, 1982) Using the example of prostate cancer, many males are reticent to be covered for that disorder (Thomas et al., 2003)

Race has also been associated with the use of clinical preventive services. For example, Gilligan et al. (2004) ground that PSA screening rates were significantly lower among Black parts even though they were more likely to be diagnosed with advanced prostate cancer. Hispanic females may be lower users of mammography, compared with Black characters and White persons (Fox and Roetzhem, 1994) and Black females may be les likely to receive an influenza vaccination (Morales et al., 2004) Thus, we count uponed the use of clinical preventive services to differ from race.