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. 2024 Feb 23:40:102663.
doi: 10.1016/j.pmedr.2024.102663. eCollection 2024 Apr.

Use of preventive service and potentially preventable hospitalization among American adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance

Elham Mahmoudi  1   2 , Paul Lin  2 , Dana Rubenstein  3 , Timothy Guetterman  1   2 , Amanda Leggett  4 , Katherine L Possin  5   6 , Neil Kamdar  2
Affiliations

Use of preventive service and potentially preventable hospitalization among American adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance

Elham Mahmoudi et al. Prev Med Rep. .

Abstract

Objective: Examine the association between traditional Medicare (TM) vs. commercial insurance and the use of preventive care and potentially preventable hospitalization (PPH) among adults (18+) with disability [cerebral palsy/spina bifida (CP/SB); multiple sclerosis (MS); traumatic spinal cord injury (TSCI)] in the United States.

Methods: Using 2008-2016 Medicare and commercial claims data, we compared adults with the same disability enrolled in TM vs. commercial insurance [Medicare: n = 21,599 (CP/SB); n = 7,605 (MS); n = 4,802 (TSCI); commercial: n = 11,306 (CP/SB); n = 6,254 (MS); n = 5,265 (TSCI)]. We applied generalized estimating equations to address repeated measures, comparing cases with controls. All models were adjusted for age, sex, race/ethnicity, and comorbid conditions.

Results: Compared with commercial insurance, enrolling in TM reduced the odds of using preventive services. For example, adjusted odds ratios (OR) of annual wellness visits in TM vs. commercial insurance were 0.31 (95% confidence interval (CI): 0.28-0.34), 0.32 (95% CI: 0.28-0.37), and 0.19 (95% CI: 0.17-0.22) among adults with CP/SB, TSCI, and MS, respectively. Furthermore, PPH risks were higher in TM vs. commercial insurance. ORs of PPH in TM vs. commercial insurance were 1.50 (95% CI: 1.18-1.89), 1.83 (95% CI: 1.40-2.41), and 2.32 (95% CI: 1.66-3.22) among adults with CP/SB, TSCI, and MS, respectively. Moreover, dual-eligible adults had higher odds of PPH compared with non-dual-eligible adults [CP/SB: OR = 1.47 (95% CI: 1.25-1.72); TSCI: OR = 1.61 (95% CI: 1.35-1.92), and MS: OR = 1.80 (95% CI: 1.55-2.10)].

Conclusions: TM, relative to commercial insurance, was associated with lower receipt of preventive care and higher PPH risk among adults with disability.

Keywords: Disability; Insurance; Medicaid; Medicare; Medicare Advantage; OptumInsight; Potentially Preventable Hospitalization; Preventive Services.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Adjusted Predicted Odds of Potentially Preventable Hospitalization Associated with Annual Wellness Visits (AWV) among Adults (18+) with a Disability in the United States: 2008–2016. Source: 2008–2016 pooled Medicare and commercial claims data. Abbreviations: OR: odds ratio; CI: confidence interval; CP/SB: cerebral palsy/spina bifida; MS: multiple sclerosis; TSCI: traumatic spinal cord injury. X-axis: odds of annual wellness visits; Y-axis: disability conditions. Note: Regression results are presented in Appendices B-D.
Fig. 2
Fig. 2
Crude Rates and Adjusted Predicted Odds of Potentially Preventable Hospitalization Comparing Different Health Insurance among Adults (18+) with a Disability in the United States: 2008–2016. (A) dual-eligible vs non-dual eligible (Adults 18+); (B) Medicare Advantage vs Traditional Medicare (Adults 65+ Only). Source: 2008–2016 pooled Medicare and commercial claims data. Abbreviations: OR: odds ratio; CI: confidence interval; CP/SB: cerebral palsy/spina bifida; MS: multiple sclerosis; TSCI: traumatic spinal cord injury. X-axis: crude rates of PPH; Y-axis: disability conditions. Note: Regression results are presented in Appendices B-D.
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