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Choice of Personal Assistance Services Providers by Medicare Beneficiaries Using a Consumer‐Directed Benefit: Rural‐Urban Differences
Author(s) -
Meng Hongdao,
Friedman Bruce,
Wamsley Brenda R.,
Van Nostrand Joan F.,
Eggert Gerald M.
Publication year - 2010
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/j.1748-0361.2010.00310.x
Subject(s) - voucher , copayment , agency (philosophy) , multivariate probit model , business , actuarial science , health care , health insurance , economics , economic growth , econometrics , philosophy , accounting , epistemology
Purpose: To examine the impact of an experimental consumer‐choice voucher benefit on the selection of independent and agency personal assistance services (PAS) providers among rural and urban Medicare beneficiaries with disabilities. Methods: The Medicare Primary and Consumer‐Directed Care Demonstration enrolled 1,605 Medicare beneficiaries in 19 counties in New York State, West Virginia, and Ohio. A total of 839 participants were randomly assigned to receive a voucher benefit (up to $250 per month with a 20% copayment) that could be used toward PAS provided by either independent or agency workers. A bivariate probit model was used to estimate the probabilities of choosing either type of PAS provider while controlling for potential confounders. Findings: The voucher was associated with a 32.4% ( P < .01) increase in the probability of choosing agency providers and a 12.5% ( P = .03) increase in the likelihood of choosing independent workers. When the analysis was stratified by rural/urban status, rural voucher recipients had 36.8% higher probability of using independent workers compared to rural controls. Urban voucher recipients had 37.1% higher probability of using agency providers compared to urban controls. Conclusions: This study provided evidence that rural and urban Medicare beneficiaries with disabilities may have very different responses to a consumer‐choice PAS voucher program. Offering a consumer‐choice voucher option to rural populations holds the potential to significantly improve their access to PAS.