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Extended coverage for preventive services for the elderly: response and results in a demonstration population
P S German1, L C Burton, S Shapiro
1Health Services Research and Development Center, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205.
Objectives:
This study was undertaken to test the acceptability of preventive services under Medicare waivers to a community-dwelling population aged 65 and over and to examine the effect of such services on health.
Methods:
Medicare beneficiaries and designated primary care providers were sampled, and beneficiaries were screened and surveyed. A total of 4195 individuals were then randomized into intervention or control groups. Those in the intervention group were offered free preventive visits (under waivers) to their physicians. A follow-up survey of the entire group was administered after completion of the intervention.
Results:
Sixty-three percent of the intervention group made a preventive clinical visit, and about half of them a counseling visit. For men, being married and having a solo practitioner were positively associated with accepting the intervention services, while for women, having had a mammogram, having a confidant, having a high school education, and having a female practitioner were so associated. The intervention group showed a greater health benefit than did the control group and had a significantly lower death rate: 8.3% vs 11.1%.
Conclusions:
Older individuals will respond to preventive programs, and such services will result in modest health gains.