ERIC Number: EJ899999
Record Type: Journal
Publication Date: 2010
Abstractor: As Provided
Reference Count: 41
Choice of Personal Assistance Services Providers by Medicare Beneficiaries Using a Consumer-Directed Benefit: Rural-Urban Differences
Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Van Nostrand, Joan F.; Eggert, Gerald M.
Journal of Rural Health, v26 n4 p392-401 Fall 2010
Purpose: To examine the impact of an experimental consumer-choice voucher benefit on the selection of independent and agency personal assistance services (PAS) providers among rural and urban Medicare beneficiaries with disabilities. Methods: The Medicare Primary and Consumer-Directed Care Demonstration enrolled 1,605 Medicare beneficiaries in 19 counties in New York State, West Virginia, and Ohio. A total of 839 participants were randomly assigned to receive a voucher benefit (up to $250 per month with a 20% copayment) that could be used toward PAS provided by either independent or agency workers. A bivariate probit model was used to estimate the probabilities of choosing either type of PAS provider while controlling for potential confounders. Findings: The voucher was associated with a 32.4% (P less than 0.01) increase in the probability of choosing agency providers and a 12.5% (P = 0.03) increase in the likelihood of choosing independent workers. When the analysis was stratified by rural/urban status, rural voucher recipients had 36.8% higher probability of using independent workers compared to rural controls. Urban voucher recipients had 37.1% higher probability of using agency providers compared to urban controls. Conclusions: This study provided evidence that rural and urban Medicare beneficiaries with disabilities may have very different responses to a consumer-choice PAS voucher program. Offering a consumer-choice voucher option to rural populations holds the potential to significantly improve their access to PAS.
Descriptors: Disabilities, Rural Urban Differences, Counties, Probability, Federal Programs, Demonstration Programs, Agencies, Vendors, Access to Health Care, Program Implementation, Program Effectiveness, Consumer Economics, Experimental Programs, Home Health Aides, Health Insurance
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Publication Type: Journal Articles; Reports - Research
Education Level: N/A
Authoring Institution: N/A
Identifiers - Location: New York; Ohio; West Virginia