Satisfaction with quality and access to health care among people with disabling conditions

Objective. To compare satisfaction with health care between persons with and without disabling conditions. Design. Responses to 1996 Medicare Current Beneficiary Survey. Setting. Nationally representative of the United States population. Study participants. Community-dwelling Medicare beneficiaries, older and younger than 65 years (n = 16 403). Main outcome measure. Adjusted odds of being dissatisfied or very dissatisfied with five general quality measures and five access-to-care measures by five disabling conditions (blind or low vision, deaf or hard of hearing, difficulty walking, difficulty reaching, manual dexterity difficulties). Multivariable logistic regressions on dissatisfaction adjusted for age group, sex, 9 disabling condition, race, ethnicity, urban versus rural residence, education, household income < $25 000 versus ≥ $25 000, having a usual source of care, proxy respondent, and managed care. Results. Of an estimated 33.58 million non-institutionalized Medicare beneficiaries, 64.1% (estimated 21.51 million) reported at least one disabling condition. Among younger beneficiaries, 10.4% with any major disability were dissatisfied with their care overall, as were 4.6% without disabilities. Nevertheless, persons with disabilities generally had significantly higher adjusted odds of dissatisfaction. For elderly persons with any major disability, the adjusted odds ratios (95% confidence interval) of dissatisfaction were: 3.2 (2.4-4.3) for overall quality; 3.2 (2.2-4.6) for access to specialists; 4.4 (3.1-6.4) for follow-up; and 4.2 (3.1-5.7) for case of getting to doctors. Elderly managed care enrollees were less satisfied with access to specialists, but more satisfied with costs. Conclusion. The quality domains generating the greatest dissatisfaction were anticipated, given the nature of disabling conditions. Improving these areas requires attention inside and outside the health care system. Redesigning practice settings and procedures, and changing payment policies offer the only solutions to some problems.