Do the Near Elderly Delay Needed Care for Chronic Conditions?

Background: Fragmented care and duplicated services have historically plagued the management of chronic conditions in the elderly, where care has focused on treating acute episodes of illness rather than chronic problems. Decisions made by the near elderly (ages 55 to 64) about the timing and types of services used to manage chronic conditions, such as diabetes and heart disease, ultimately affect their health status and patterns of health care use at the time of Medicare enrollment. Objectives: This project examined the factors associated with decisions to delay care versus seek timely care by the near elderly with chronic conditions prior to becoming eligible for Medicare. We also examined how health insurance coverage influenced these decisions. Methodology: We used a series of in-depth interviews with individuals ages 65 to 67 who had either diabetes, arthritis, hypertension or heart disease to identify reasons for delaying versus seeking care for their chronic condition(s). Interviews were tape recorded and transcribed, and content analysis was used to identify key themes that influenced health care decisions. A written survey was used to validate the key themes important to the decision making process. Results: Twenty-three 90-minute interviews were conducted. The content analysis identified eleven key motivators for and against seeking health care, ranging from reasons related to financial cost (100%), their own and others' experiences with a treatment (71% and 65% respectively) to positive and negative attitudes about prescription drugs (59%) and health care providers (59%). Conclusions: The key informant interviews provided a detailed understanding of the decision making processes and money-health trade-offs made by the near elderly. Results of this study will directly inform the policy debate on the Medicare eligibility age by filling an important void in understanding the implications of uninsurance and under-insurance as well as non-financial factors on health care costs