Access to ambulatory medical and long-term care services among elderly medicare and medicaid beneficiaries: Organizational, financial, and geographic barriers

Marlene R. Niefeld, Judith D. Kasper

Research output: Contribution to journalArticle


The comprehensive insurance coverage afforded low-income elders with both Medicare and Medicaid coverage (dual enrollees) has substantially reduced financial barriers to care. However, other studies show reduced and less appropriate utilization patterns among dual enrollees compared to Medicare beneficiaries with private supplemental insurance, suggesting access barriers remain. This study found that 59 percent of elderly dual enrollees needed an ambulatory medical or long-term care service in a 1-year period. One third of these individuals experienced barriers to access; organizational and geographic barriers were more prevalent than financial barriers. African American race, trouble paying basic living expenses, fair or poor health status, and an unfavorable assessment of physician information giving were significantly associated with an increased likelihood of organizational and geographic access barriers among elderly dual enrollees.

Original languageEnglish (US)
Pages (from-to)300-319
Number of pages20
JournalMedical Care Research and Review
Issue number3
Publication statusPublished - Jun 2005



  • Access to care
  • Dual eligibles
  • Dual enrollees
  • Elderly
  • Medicaid
  • Medicare

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

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