The impact of marital status on health care utilization among Medicare beneficiaries

被引:93
作者
Pandey, Kiran Raj [1 ]
Yang, Fan [2 ]
Cagney, Kathleen A. [3 ]
Smieliauskas, Fabrice [4 ]
Meltzer, David O. [1 ,5 ]
Ruhnke, Gregory W. [5 ]
机构
[1] Univ Chicago, Ctr Hlth & Social Sci, 5841 South Maryland Ave,MC 1000, Chicago, IL 60637 USA
[2] Univ Colorado Denver, Dept Biostat & Informat, Aurora, CO USA
[3] Univ Chicago, Dept Sociol, Chicago, IL 60637 USA
[4] Univ Chicago, Dept Publ Hlth Sci, Chicago, IL 60637 USA
[5] Univ Chicago, Sect Hosp Med, Dept Med, Chicago, IL 60637 USA
关键词
healthcare utilization; inpatient; marriage; medicare; outpatient; skilled nursing facility; MARRIAGE PROTECTION; MORTALITY; HOSPITALIZATION; POPULATION; DETERMINANTS; CONTINUITY; SELECTION; GENDER; ACCESS; COSTS;
D O I
10.1097/MD.0000000000014871
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
To explain prior literature showing that married Medicare beneficiaries achieve better health outcomes at half the per person cost of single beneficiaries, we examined different patterns of healthcare utilization as a potential driver. Using the Medicare Current Beneficiary Survey (MCBS) data, we sought to understand utilization patterns in married versus currently-not-married Medicare beneficiaries. We analyzed the relationship between marital status and healthcare utilization (classified based on setting of care utilization into outpatient, inpatient, and skilled nursing facility (SNF) use) using logistic regression modeling. We specified models to control for possible confounders based on the Andersen model of healthcare utilization. Based on 13,942 respondents in the MCBS dataset, 12,929 had complete data, thus forming the analytic sample, of whom 6473 (50.3%) were married. Of these, 58% (vs. 36% of those currently-not-married) were male, 45% (vs. 47%) were age > 75, 24% (vs. 70%) had a household income below $ 25,000, 18% (vs. 14%) had excellent self-reported general health, and 56% (vs. 36%) had private insurance. Compared to unmarried respondents, married respondents had a trend toward higher odds of having a recent outpatient visit (unadjusted odds ratio (OR) 1.11, 95% confidence interval (CI) 1.04-1.19, adjusted odds ratio (AOR) 1.10, (CI) 0.991.22), and lower odds in the year prior to have had an inpatient stay (AOR 0.84, CI 0.72-0.99) or a SNF stay (AOR 0.55, CI 0.40-0.75). Based on MCBS data, odds of self-reported inpatient and SNF use were lower among married respondents, while unadjusted odds of outpatient use were higher, compared to currently-not-married beneficiaries.
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页数:8
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