Menzies Center for Health Policy, University of Sydney, Sydney, New South Wales, Australia.
Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2020 Oct;68(10):2336-2342. doi: 10.1111/jgs.16705. Epub 2020 Aug 3.
BACKGROUND/OBJECTIVES: Medicare has become an increasingly complex program to navigate with numerous choices available to beneficiaries with important implications for their financial exposure and access to care. Although research has identified poor health literacy as a barrier to understanding Medicare, little information is available on the experience of individuals with hearing loss. This study examined how hearing loss impacts Medicare beneficiaries in understanding the program, their ability to compare and review plan options, and their satisfaction with available information.
Cross-sectional analysis using multivariate ordinal logistic regression.
Nationally representative survey of Medicare beneficiaries in the United States (Medicare Current Beneficiary Survey [MCBS]) 2017.
A total of 10,510 Medicare beneficiaries were analyzed, representing 50,084,169 beneficiaries with survey weights applied.
The primary outcome was difficulty understanding Medicare, determined by this MCBS question: "Overall, how easy or difficult do you think the Medicare program is to understand?" The predictor of interest was self-reported hearing loss measured categorically as no trouble, a little trouble, and a lot of trouble hearing. Covariates included age, sex, race, educational attainment, household income relative to the federal poverty level, enrollment in either traditional Medicare or Medicare Advantage, dementia diagnosis, trouble with vision, and number of chronic conditions.
Medicare beneficiaries with a little or a lot of trouble hearing had 18% (95% confidence interval [CI] odds ratio [OR] = 1.10-1.27) and 25% (95% CI OR = 1.07-1.47) increased odds of reporting greater difficulty with understanding Medicare, respectively, compared with those with no hearing trouble. About one in five Medicare beneficiaries with hearing loss identified that their hearing made it difficult to find Medicare information.
The existing tools to support Medicare beneficiaries' understanding and navigation of the program must evolve to meet the needs of those with hearing loss, a highly prevalent condition among Medicare beneficiaries. J Am Geriatr Soc 68:2336-2342, 2020.
背景/目的：随着医疗保险（Medicare）向受益人提供的选择越来越多，该计划变得日益复杂，这对他们的财务风险和获得医疗服务的机会产生了重要影响。尽管研究已经确定健康素养较差是理解医疗保险的障碍，但关于听力损失者的体验，相关信息却很少。本研究调查了听力损失如何影响医疗保险受益人理解该计划、比较和审查计划选择的能力，以及他们对现有信息的满意度。
使用多变量有序逻辑回归进行横断面分析。
对美国医疗保险受益人的全国代表性调查（医疗保险当前受益人调查[MCBS]）2017 年的数据。
分析了总共 10510 名医疗保险受益人，代表经调查权重调整后的 50084169 名受益人。
主要结果是理解医疗保险的困难程度，通过 MCBS 中的这个问题来确定：“总体而言，您认为 Medicare 计划容易理解吗？”感兴趣的预测因子是自我报告的听力损失，分为无听力问题、有一点听力问题和有很多听力问题。协变量包括年龄、性别、种族、教育程度、家庭收入相对于联邦贫困线、是否参加传统 Medicare 或 Medicare Advantage、痴呆症诊断、视力问题和慢性疾病数量。
有一点或很多听力问题的医疗保险受益人报告理解 Medicare 有较大困难的几率分别增加了 18%（95%置信区间[OR] = 1.10-1.27）和 25%（95% CI OR = 1.07-1.47），与无听力问题的受益人相比。约五分之一的听力损失的 Medicare 受益人表示，听力问题使他们难以找到 Medicare 信息。
支持 Medicare 受益人理解和使用该计划的现有工具必须发展，以满足听力损失者的需求，而听力损失是 Medicare 受益人的一个高发疾病。美国老年学会杂志 68：2336-2342，2020。
