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Extended coverage for preventive services for the elderly: response and results in a demonstration population.

P S German, L C Burton, S Shapiro, D M Steinwachs, I Tsuji, M J Paglia and A M Damiano

Health Services Research and Development Center, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205.

OBJECTIVES. This study was undertaken to test the acceptability of preventive services under Medicare waivers to a community-dwelling population aged 65 and over and to examine the effect of such services on health. METHODS. Medicare beneficiaries and designated primary care providers were sampled, and beneficiaries were screened and surveyed. A total of 4195 individuals were then randomized into intervention or control groups. Those in the intervention group were offered free preventive visits (under waivers) to their physicians. A follow-up survey of the entire group was administered after completion of the intervention. RESULTS. Sixty-three percent of the intervention group made a preventive clinical visit, and about half of them a counseling visit. For men, being married and having a solo practitioner were positively associated with accepting the intervention services, while for women, having had a mammogram, having a confidant, having a high school education, and having a female practitioner were so associated. The intervention group showed a greater health benefit than did the control group and had a significantly lower death rate: 8.3% vs 11.1%. CONCLUSIONS: Older individuals will respond to preventive programs, and such services will result in modest health gains.

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