Unmet Need for Medical Care Among Fee-for-Service Medicare Beneficiaries with High and Low Need.

Abstract

Unmet need for medical care is common among Medicare beneficiaries, but less is known whether unmet need differs between those with high and low levels of need. To examine unmet need for medical care among fee-for-service (FFS) Medicare beneficiaries by level of care need. We included 29,123 FFS Medicare beneficiaries from the 2010-2016 Medicare Current Beneficiary Survey. Our outcomes included three measures of unmet need for medical care. We also examined the reasons for not obtaining needed medical care. Our primary independent variable was a categorization of groups by levels of care need: those with low need (the relatively healthy and those with simple chronic conditions) and those with high need (those with minor complex chronic conditions, those with major complex chronic conditions, the frail, and the non-elderly disabled). The rates of reporting unmet need for medical care were highest among the non-elderly disabled (23.5% [95% CI: 19.8-27.3] for not seeing a doctor despite medical need, 23.8% [95% CI: 20.0-27.6] for experiencing delayed care, and 12.9% [95% CI: 10.2-15.6] for experiencing trouble in getting needed care). However, the rates of reporting unmet need were relatively low among the other groups (ranging from 3.1 to 9.9% for not seeing a doctor despite medical need, from 3.4 to 5.9% for experiencing delayed care, and from 1.9 to 2.9% for experiencing trouble in getting needed care). The most common reason for not seeing a doctor despite medical need was concerns about high costs for the non-elderly disabled (24%), but perception that the issue was not too serious was the most common reason for the other groups. Our findings suggest the need for targeted policy interventions to address unmet need for non-elderly disabled FFS Medicare beneficiaries, especially for improving affordability of care.