Rural and Urban Differences in Utilization of Formal Home Care

Lead researcher:
Project completed:
August 2005
This project is using the Medical Expenditure Panel Survey Household Component (MEPS-HC), the Area Resource File, CMS Provider of Service data, and other data sources to examine rural and urban differences in the utilization and costs of formal home care, including changes in utilization patterns and costs across residence types over time. The paper, based upon the 1998 MEPS-HC data, examined the factors that predict use of formal home care, including rurality. A major finding is that without adjustments older people in more rural counties (nonmetropolitan counties having no town of 10,000) are significantly more likely to use any formal health care, as well as Medicare home health care. Fully adjusted logistic analysis results point to an interplay between residential status and Medicaid coverage with regard to formal home care use. In comparison with metropolitan residents covered by Medicaid, the adjusted relative risk of formal home care use from any source is significantly higher for Medicaid enrollees residing in nonmetropolitan counties having no people of 10,000 or more. Use of Medicare home health care is significantly greater for residents of the most rural counties, irrespective of their Medicaid coverage, as well as Medicaid-covered residents of nonmetropolitan counties having a town of at least 10,000 people. A second paper, examining rural and urban differences in the cost of formal home care, is in process. Following these papers, more in-depth analyses of rural and urban differences in utilization and cost trends will be completed. The MEPS-HC is a very useful resource for the examination of formal home care utilization because its question format leads to the gathering of information on reimbursed home care of all types and from all sources.

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