Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

May Kennedy


OBJECTIVE: To investigate the relationship between Medicare Managed Care (MMC) penetration and percentage of disability in older adults (individuals age 65 and older). Considering disability as an indicator of one or more unsuccessfully managed chronic diseases, this study investigates the assumption that managed care improves coordination of care, as well as access to preventive care. If managed care’s mandate is being met, then it should be evidenced in decreased prevalence of older adult disability. METHOD: Taking an ecological approach, this study used data from the Agency for Healthcare Research and Quality (AHRQ, 2003) to compare the percentage of older adult disability in counties from 30 states and the District of Columbia with high and low MMC penetration. Covariates representing various aspects of community context were introduced into a final multivariate linear regression to examine whether MMC penetration was a significant predictor of countywide percent of older adult disability. RESULTS: While MMC penetration was a significant predictor of prevalence of older adult disability in a bivariate analysis (r=-0.197, p < .001), it lost its significance in the final multivariate model. CONCLUSION: While this study does not demonstrate a relationship between MMC penetration and prevalence of older adult disability, it is possible that MMC, once fully implemented under the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, could lead to reduced prevalence of disability.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2008

Included in

Epidemiology Commons