@article {7727, title = {Despite {\textquoteright}welcome to Medicare{\textquoteright} benefit, one in eight enrollees delay first use of part B services for at least two years.}, journal = {Health Aff (Millwood)}, volume = {31}, year = {2012}, month = {2012 Jun}, pages = {1260-8}, publisher = {31}, abstract = {

Much research has focused on the possible overuse of health care services within Medicare, but there is also substantial evidence of underuse. In recent years, Congress has added a "welcome to Medicare" physician visit and a number of preventive services with no cost sharing to the Medicare benefit package to encourage early and appropriate use of services. We examined national longitudinal data on first claims for Part B services-the portion of Medicare that covers physician visits-to learn how people used these benefits. We found that 12 percent of people, or about one in eight, who enrolled in Medicare at age sixty-five waited more than two years before making their first use of care covered by Part B. In part, this delay reflected patterns of use before enrollment, in that people who sought preventive care before turning sixty-five continued to do so after enrolling in Medicare. Enrollees with Medigap coverage, higher household wealth, and a higher level of education typically received care under Part B sooner than others, whereas having greater tolerance for risk was more likely to lead enrollees to delay use of Part B services. Men had a lower probability of using Part B services early than women; blacks and members of other minority groups were less likely to use services early than whites. Although the "welcome to Medicare" checkup does not appear to have had a positive effect on use of services soon after enrollment, the percentage of beneficiaries receiving Part B services in the first two years after enrollment has steadily increased over time. Whether or not delays in receipt of care should be a considerable public policy concern may depend on what factors are leading specific categories of enrollees to delay care and how such delays affect health.

}, keywords = {Aged, Female, Humans, Insurance Claim Review, Male, Medicare Part B, Time Factors, United States}, issn = {1544-5208}, doi = {10.1377/hlthaff.2011.0479}, author = {Frank A Sloan and Kofi F Acquah and Paul P Lee and Devdutta G. Sangvai} } @article {7007, title = {Effects of Changes in Self-Reported Vision on Cognitive, Affective and Functional Status and Living Arrangements Among the Elderly}, journal = {American Journal of Ophthalmology}, volume = {140}, year = {2005}, pages = {618-27}, publisher = {140}, abstract = {PURPOSE: To study effects of changes in self-reported vision on functional status, cognition, depressive symptoms, and living arrangements. DESIGN: Longitudinal analysis of household survey data. METHODS: A total of 6234 sample persons observed in the study of Assets and Health Dynamics Among the Oldest Old (AHEAD) 1995 were followed in 1998, 2000, and 2002 or until death or sample attrition. Effects of changes in self-reported vision and other factors were assessed by means of ordinary least-squares and logistic regression with panel data methods. Main outcome measures were limitations of instrumental activities of daily living (IADLs), activities of daily living (ADLs), and other, cognition, depressive symptoms, and living arrangements. RESULTS: A decline from excellent/good vision to fair/poor near and distance vision had statistically significant effects on several IADL limitations, and some ADL and other limitations. Largest effects were for driving (OR for no limitation: 0.55, P = .003), managing money (OR: 0.61, P .001), and preparing hot meals (OR: 0.61, P .001). Onset of fair-poor near vision increased the likelihood of onset of at least one IADL (OR for no limitation: 0.71, P .01) and ADL (OR: 0.74, P = .003) limitation. Onset of legal blindness resulted in a 78 increase in the likelihood of an IADL limitation (OR for no limitation: 0.22, P .001). Effects of vision declines on cognition and depressive symptoms were statistically significant but small. Decline in vision increased the probability of nursing home residence. CONCLUSIONS: Visual impairment has major impacts on functional status. Preventing vision loss is likely to appreciably improve the functioning of elderly persons.}, keywords = {Demographics, Health Conditions and Status}, author = {Frank A Sloan and Ostermann, Jan and Derek S. Brown and Paul P Lee} } @article {6639, title = {The associations between self-rated vision and hearing and functional status in middle age.}, journal = {Ophthalmology}, volume = {106}, year = {1999}, month = {1999 Feb}, pages = {401-5}, publisher = {106}, abstract = {

OBJECTIVES: To describe the associations between self-reported visual and hearing impairment and an index of global functional status among community-dwelling, middle-aged Americans.

DESIGN: Cross-sectional.

PARTICIPANTS: A total of 9744 U.S. community-dwelling persons 51 to 61 years of age participated.

METHODS: Multivariate analyses of functional status based on cross-sectional data from Wave I (1992) of the Health and Retirement Study (HRS), controlling for demographic and socioeconomic status, common chronic medical conditions, and general health status, were performed.

MAIN OUTCOME MEASURE: A global index of functional status based on self-reported limitations in 17 activities was measured.

RESULTS: Approximately 3\% of respondents in the HRS rated their vision or hearing as poor. Even after controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. In addition, controlling for income, wealth, and education reduced the strength of the associations between vision and hearing impairment and function, but did not eliminate them. The magnitude of effect of poor vision exceeded all medical conditions except stroke.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship with overall functional status, among even community-dwelling, middle-aged Americans and even after controlling for general health status, medical comorbidities, and socioeconomic status.

}, keywords = {Cross-Sectional Studies, Female, health, Health Status, Health Surveys, Hearing Disorders, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Quality of Life, Self Disclosure, Vision Disorders}, issn = {0161-6420}, doi = {10.1016/S0161-6420(99)90082-9}, url = {http://www.ncbi.nlm.nih.gov/pubmed/9951498?dopt=Abstract}, author = {Paul P Lee and James P Smith and Raynard Kington} } @article {6673, title = {The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older.}, journal = {Am J Ophthalmol}, volume = {127}, year = {1999}, month = {1999 Apr}, pages = {447-52}, publisher = {127}, abstract = {

PURPOSE: To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older.

METHODS: A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision.

RESULTS: Of the respondents, 27\% rated their vision as fair or poor, whereas 25\% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, hearing, Hearing Disorders, Humans, Male, Multivariate Analysis, Quality of Life, Self Disclosure, Surveys and Questionnaires, Vision Disorders, Vision, Ocular, Visual Acuity}, issn = {0002-9394}, doi = {10.1016/s0002-9394(98)00418-8}, author = {Paul P Lee and James P Smith and Raynard Kington} }