Variation in Tertiary Prevention and Health Service Utilization among the Elderly: The Role of Urban-Rural Residence and Supplemental Insurance

Kenneth G. Saag, Bradley Doebbeling, James E. Rohrer, Sheela Kolluri, Rachel Peterson, Mark E. Hermann, Robert B. Wallace

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives. Tertiary prevention seeks to reduce chronic disease progression and illness-related dysfunction. Using the Aday-Andersen model, we evaluated the impact of predisposing, need, and enabling factors on tertiary prevention, hypothesizing that urban-rural geographic differences in delivery would be detected. Methods. A population-based telephone survey was conducted evaluating six common chronic indicator conditions: arthritis (n = 488), hypertension (n = 414), cardiac disease (n = 185), diabetes mellitus (n = 125), peptic ulcer disease (n = 125) and chronic obstructive pulmonary disease (n = 103). Subjects were 787 (70% women) home-dwelling elderly (age > 65 years) who had one or more of the indicator conditions and who resided in Iowa's 12 most rural and 10 most urban counties. Tertiary prevention measures included counseling for and/or treatment with: influenza and pneumococcal vaccination, smoking cessation, dietary modifications, exercise, drug side effects, chronic disease rehabilitation, aspirin/estrogen for cardiac disease, and foot/eye care for diabetes. Tertiary prevention scores were calculated to compare preventive services across disease categories and to examine relations, in particular, with enabling factors. Results. Education beyond high school, alcohol use, cigarette smoking, and medical specialist use were all significantly greater among urban residents, whereas home services use was greater among rural residents. Respondents with either health maintenance organization or fee-for-service supplemental coverage had higher tertiary prevention scores than respondents without supplemental coverage. After adjustment for the significant effects of the number of diseases, higher income, and place of residence, rural respondents having health maintenance organization supplemental coverage had higher (better) tertiary prevention scores than other respondents. Conclusions. In this community-based study of elderly, enrollment in an health maintenance organization plan, as opposed to a fee-for-service supplement to Medicare, increased tertiary prevention quality for rural but not for urban residents. This study emphasizes that additional research is needed to evaluate the importance of specific types of insurance coverage for preventive services among the elderly.

Original languageEnglish (US)
Pages (from-to)965-976
Number of pages12
JournalMedical Care
Volume36
Issue number7
StatePublished - Jul 1998
Externally publishedYes

Fingerprint

Tertiary Prevention
Insurance
insurance
Health Services
health service
utilization
Disease
Health Maintenance Organizations
Causality
Fee-for-Service Plans
Chronic Disease
coverage
resident
Heart Diseases
organization
fee
chronic illness
smoking
Diet Therapy
health

Keywords

  • Access
  • Aging
  • Health service utilization
  • Insurance
  • Prevention
  • Quality of care
  • Rural health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Saag, K. G., Doebbeling, B., Rohrer, J. E., Kolluri, S., Peterson, R., Hermann, M. E., & Wallace, R. B. (1998). Variation in Tertiary Prevention and Health Service Utilization among the Elderly: The Role of Urban-Rural Residence and Supplemental Insurance. Medical Care, 36(7), 965-976.

Variation in Tertiary Prevention and Health Service Utilization among the Elderly : The Role of Urban-Rural Residence and Supplemental Insurance. / Saag, Kenneth G.; Doebbeling, Bradley; Rohrer, James E.; Kolluri, Sheela; Peterson, Rachel; Hermann, Mark E.; Wallace, Robert B.

In: Medical Care, Vol. 36, No. 7, 07.1998, p. 965-976.

Research output: Contribution to journalArticle

Saag, Kenneth G. ; Doebbeling, Bradley ; Rohrer, James E. ; Kolluri, Sheela ; Peterson, Rachel ; Hermann, Mark E. ; Wallace, Robert B. / Variation in Tertiary Prevention and Health Service Utilization among the Elderly : The Role of Urban-Rural Residence and Supplemental Insurance. In: Medical Care. 1998 ; Vol. 36, No. 7. pp. 965-976.
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abstract = "Objectives. Tertiary prevention seeks to reduce chronic disease progression and illness-related dysfunction. Using the Aday-Andersen model, we evaluated the impact of predisposing, need, and enabling factors on tertiary prevention, hypothesizing that urban-rural geographic differences in delivery would be detected. Methods. A population-based telephone survey was conducted evaluating six common chronic indicator conditions: arthritis (n = 488), hypertension (n = 414), cardiac disease (n = 185), diabetes mellitus (n = 125), peptic ulcer disease (n = 125) and chronic obstructive pulmonary disease (n = 103). Subjects were 787 (70{\%} women) home-dwelling elderly (age > 65 years) who had one or more of the indicator conditions and who resided in Iowa's 12 most rural and 10 most urban counties. Tertiary prevention measures included counseling for and/or treatment with: influenza and pneumococcal vaccination, smoking cessation, dietary modifications, exercise, drug side effects, chronic disease rehabilitation, aspirin/estrogen for cardiac disease, and foot/eye care for diabetes. Tertiary prevention scores were calculated to compare preventive services across disease categories and to examine relations, in particular, with enabling factors. Results. Education beyond high school, alcohol use, cigarette smoking, and medical specialist use were all significantly greater among urban residents, whereas home services use was greater among rural residents. Respondents with either health maintenance organization or fee-for-service supplemental coverage had higher tertiary prevention scores than respondents without supplemental coverage. After adjustment for the significant effects of the number of diseases, higher income, and place of residence, rural respondents having health maintenance organization supplemental coverage had higher (better) tertiary prevention scores than other respondents. Conclusions. In this community-based study of elderly, enrollment in an health maintenance organization plan, as opposed to a fee-for-service supplement to Medicare, increased tertiary prevention quality for rural but not for urban residents. This study emphasizes that additional research is needed to evaluate the importance of specific types of insurance coverage for preventive services among the elderly.",
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