Do Elderly Medicare Recipients Contact Physicians Appropriately

Objectives. This research identified characteristics of persons and their illness episodes that predict appropriate and inappropriate decisions to seek medical care. Methods. This study analyzes 1,292 health care decisions of 885 elderly members of an HMO in Los Angeles. Illness episodes are divided into three categories based on the expertise of a panel of 22 geriatricians, using a formal mathematical analysis derived from anthropological consensus theory. These categories are physician visit not recommended, physician visit recommended, and physician visit mandatory. Physician contact is regressed on a list of variables derived from Andersen’s behavioral model separately for each group of episodes. Results. Although the variables indicating perceived seriousness and duration of the episode consistently predict the decision to contact a physician, regardless of whether that contact is considered appropriate by the geriatrician panel, the variables indicating other illness responses and predisposing personal attributes have less consistent patterns of significance. Discussion. The category of episodes (visit recommended) for which predisposing personal attributes figure most strongly in the treatment decision is the one for which there are no clear cultural directives to action. Implications for health education and policy are drawn from the findings. OMMUNITY-DWELLING older adults are responsible for a significant proportion of the discretionary physician visits made in the United States. Given an increasing concern over the equitable allocation of scarce medical resources, it is particularly important for health policy makers and planners to understand factors associated with decisions to seek medical care when dealing with acute symptoms or flare-ups of chronic conditions. This study presents a multidisciplinary approach to identifying predictors of appropriate and inappropriate decisions about medical care-seeking for specific illness episodes. It divides a sample of illness episodes experienced in 1986 and 1987 by Medicare recipients in an HMO into three groups based on the consensus of 22 physicians as to whether medical care is mandatory, recommended, or not recommended. It then evaluates predictors of physician contact selected from the health services use literature.