Forgoing Physician Visits Because of Cost: A Source of Health Disparities for Elderly People With Disabilities?

Lee JC, Heinemann AW. Forgoing physician visits because of cost: a source of health disparities for elderly people with disabilities? Arch Phys Med Rehabil 2010;91: 1319-26. Objective: To examine disparities in having a usual source of care and forgoing physician visits because of cost between elderly people (age >= 65y) with and without disabilities after consecutively controlling for predisposing, enabling, and perceived and evaluated health need factors using the Andersen behavioral model, and to identify the determinants of such disparities. Design: Cross-sectional analysis. Setting: Community. Participants: Nationally representative sample of community-dwelling adults age 65 years or greater in the United States from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) (N=93,933). Interventions: Not applicable. Main Outcome Measures: Responses to 2 BRFSS questions: (1) whether the respondent had a health care provider, and (2) whether the respondent had forgone seeing a physician because of cost in the past 12 months. Results: After controlling for the aforementioned factors, elderly persons with disabilities were more likely than their counterparts without disabilities to have a usual source of care (adjusted odds ratio [AOR] = 1.33; 95% confidence interval [CI], 1.08-1.64), and those with disabilities were more likely to forgo physician visits because of cost (AOR=1.64; 95% CI, 1.31-2.04). The unadjusted odds of forgoing physician visits (odds ratio [OR]=2.13; 95% Cl, 1.87-2.43) did not decrease after controlling for predisposing factors (AOR=2.32; 95% CI, 1.96-2.75), whereas the odds were attenuated after controlling for enabling factors (AOR=2.18; 95% CI, 1.84-2.59), perceived health need (AOR=1.70; 95% Cl, 1.37-2.12), and evaluated health need (AOR=1.64; 95% Cl, 1.31-2.04). Conclusions: Although elderly people with disabilities were more likely than their counterparts without disabilities to have a usual source of care, those with disabilities were more likely to forgo physician visits because of cost. Elderly persons with greater perceived health needs were most likely to experience the disparity.