| Over 6 million people, aged 65 and older, are enrolled in managed-care organizations. The fastest growing subgroup within this population is comprised of those 85 years of age and older, totaling 4.0 million in 1998---a figure 33 times greater than in 1900. This study describes experiences of elderly enrollees of health-maintenance organizations during the process of trying to obtain needed health-care services. The data were collected through individual audiotaped interviews followed by two focus-group sessions of 50 community-dwelling enrollees, aged 75 years and older. Each participant was interviewed twice and 16 were self-selected for inclusion in two follow-up focus groups. The following four instruments were used to collect data: (a) an interview and focus-group guide, (b) a demographic profile, (c) the Mental Status Questionnaire, and (d) the Medical Outcomes Study 36-Item Short-Form Health Survey. Ethnographic inquiry was incorporated to elicit a clear understanding of what occurs during this process, as perceived by older people seeking care. Andersen's Model of Health Services Use served as the conceptual framework of the research, defining the assumptions and philosophical stance of the study.; Data were analyzed using descriptive statistics and content analysis to identify common themes. The findings indicate that factors influencing the ability of elderly people to access health-care services are complex, multidimensional, and may manifest both individually and cumulatively. The following four broad categories of factors emerged from the data: clinical (i.e., vague symptomatology, age-associated thermoregulatory changes, sensory deficits, and cognitive and functional impairment); cultural (i.e., language barriers); social (i.e., ageism, female gender bias, family advocacy); and environmental (i.e., automated telephone-answering devices, transportation, knowledge and training among care providers, delayed referrals to specialized services). The most predominant factor was the inability of the participants to negotiate automated telephone-answering devices (n = 50, 100%). The cumulative, overlapping effect of these multiple factors negatively affects the ability of frail, older HMO enrollees to access needed health-care services. Consequently, this affects the utilization of preventive, urgent, and crisis health-care services, as well as referrals to specialized services. These services are useless to older consumers if they are unable to negotiate the process of access. |
