Access to care and satisfaction with care among fee-for-service Medicare beneficiaries by level of care need

Background: Variation among fee-for-service (FFS) Medicare beneficiaries by level of care need for access to care and satisfaction with care is unknown. Objective: We examined access to care and satisfaction with care among FFS Medicare beneficiaries by level of care need. Methods: We employed a cross-sectional study design. Using the Medicare Current Beneficiary Survey, we categorized 17,967 FFS Medicare beneficiaries into six groups based on level of care need: the relatively healthy (11.0%), those with simple chronic conditions (26.1%), those with minor complex chronic conditions (28.6%), those with major complex chronic conditions (14.2%), the frail (6.2%), and the non-elderly disabled or end-stage renal disease (ESRD) (13.9%). Outcome measures included multiple indicators for access to care and satisfaction with care. For each outcome, we conducted a linear probability model while adjusting for individual-level and county-level characteristics and estimated the adjusted value of the outcome by level of care need. Results: The non-elderly disabled or ESRD were more likely to experience limited access to care and poor satisfaction with care than other five care need groups. Particularly, the rates of reporting trouble accessing needed medical care were the highest among the non-elderly disabled or ESRD (12.4% [95% CI: 9.6–15.3] vs. 2.1 [95% CI: 1.5–2.8] to 2.5 [95% CI: 1.6–3.5]). The leading reason for trouble accessing needed care among the non-elderly disabled or ESRD was attributable to affordability (59.6%). Conclusions: Policymakers need to develop targeted approaches to improve access to care and satisfaction with care for the non-elderly with a disability or ESRD.