The Response to Medicare

Abstract

I MPLEMENTATION of title XVIII of Public Law 89-97 (Medicare) presented a unique opportunity to study several facets of social cha,nge because Medicare is a large-scale innovation in the philosophy and method olf payment for health and medical care services for the aged. This paper concerns the response to Medicare by a sample of the older population in five selected Midwestern communities. The focus of this report is on (a) awareness of and knowledge about Medicare and (b) expressed attitudes toward the program by older people. IData for this study were collected under the terms of a subcontract with National Analysts, Inc., Philadelphia. Personal interviews were conducted with 2,622 respondents age 6( or older in olne metropolitan area, two large cities, and two small cities. The communities were selected to provide information from cities, of different sizes with differences in medical care resources such as physician-specialists, nurses, and other professional personnel; facilities, including hospitals, clinics, and nursing homes; and programs, for example, services of visiting nurse associations and local health departments. The metropolitan area, subsequently referred to as Metropolis, is a city of more than 500,000 population with the full range of medical care resources. Two large cities, Center City and Ozark City, each have a population of approximately 100,000 but differ in the amount and kinds of health resources. Center City has access to a nearby State medical school and affiliated hospital. Two smaller communities, Prairietown and Watertown, are in counties each with a population of about 30,000. Both are centers to which persons come from outlying rural areas for initial medical care. However, Prairietown has more medical care resources than Watertown. There was very little difference in the distribution of respondents by age or sex in the five communities (table 1). The only statistically significant Negro population, however, was in the metropolitan area. Each of the five communities was divided into segments with approximately the same size population although the size of the segment varied from one community to another. Segments then were selected by random numbers for screening for eligible households. An eligible household was one that had at least one person aged 60 or over who was able to be interviewed and who consented to being interviewed. The proportion of eligible households ranged from 26.4 percent in Center Dr. Coe is associate professor of sociology and director, Medical Care Research Center, Washington University, St. Louis, Mo. Dr. Friedmann is professor and chairman, department of sociology, Kansas State University, Manhattan. Mr. Sigler is research associate, Institute for Community Studies, Kansas City, Mo. Dr. Marshall is professor and chairman, department of rural sociology, University of Wisconsin, Madison. Mr. Brehm is chief, Behavioral Studies Section, Office of Research and Development, Public Health Service. This study was conducted under Public Health Service grant CD-00244 to the Midwest Council for Research in Aging.