Access to Care and Utilization of Services

Fifty-nine percent of the decedents were reported to be covered by some form of private insurance or HMO. Almost 75 percent were covered by Medicare.

Number and percent of decedents covered by selected insurance programs: United States, 1993

Selected coverage programs	Number	Percent¹	Standard error of percent	95 percent confidence interval (+/- percent)
Private insurance or HMO	1,301,000	58.7	0.9562	1.9
Medicare	1,649,000	74.4	0.7765	1.5
Medicaid	554,000	25.0	0.8355	1.6
VA	139,000	6.3	0.4500	0.9
Worker’s Compensation	37,000	1.7	0.2441	0.5

¹ Percents based on 2,215,000 decedents.

NOTES: Excludes deaths to persons under 15 years of age and those deaths occurring in South Dakota. Standard errors are estimated using the statistical software package SUDAAN.

SOURCE: NCHS, National Mortality Followback Survey — provisional data, 1993.

Of the decedents who were reported to need but did not receive health care, one-third were reported to have had problems paying bills. Eighteen percent were reported to have had problems finding or getting treatment.

Number and percent of decedents needing but not receiving health care by source of problem: United States, 1993

Source of problem	Number	Percent¹	Standard error of percent	95 percent confidence interval (+/- percent)
Finding or getting into a facility	26,000	13.4	2.2999	4.5
Finding or getting treatment	35,000	18.5	2.6125	5.1
Getting help at home	13,000	6.6	1.4177	2.8
Paying bills	63,000	32.8	3.0377	6.0
Transportation	16,000	8.2	1.7143	3.4

¹ Percents based on 191,000 decedents needing but not receiving health care.

NOTES: Excludes deaths to persons under 15 years of age and those deaths occurring in South Dakota. Standard errors are estimated using the statistical software package SUDAAN.

SOURCE: NCHS, National Mortality Followback Survey — provisional data, 1993.

Almost an equal number of decedents living at home during the last year of life were reported to have used a hospital bed (19-percent) and/or oxygen or a device for breathing therapy (18-percent).

Number and percent of decedents living at home during the last year of life who are reported to have used selected medical equipment: United States, 1993

Medical equipment	Number	Percent1	Standard error of percent	95 percent confidence interval (+/- percent)
Dialysis machine	28,000	1.4	0.2584	0.5
Hospital bed	371,000	19.3	0.8155	1.6
Blood glucose monitor	134,000	7.0	0.5704	1.1
Protective restraints	33,000	1.7	0.2871	0.6
Infusion pump	68,000	3.6	0.3742	0.7
Oxygen or device for breathing therapy	347,000	18.1	0.7908	1.5

1Percents based on 1,918,000 decedents living at home during the last year of life.

NOTES: Excludes deaths to persons under 15 years of age and those deaths occurring in South Dakota. Standard errors are estimated using the statistical software package SUDAAN.

SOURCE: NCHS, National Mortality Followback Survey — provisional data, 1993.

While 10 percent of the decedents were reported to have never visited a doctor during their last year of life, 9 percent were reported to have seen a doctor 50 or more times.

Number and percent distribution of decedents by number of times they were seen by a medical doctor during the last year of life: United States, 1993

Sources of payment	Number	Percent	Standard error of percent	95 percent confidence interval (+/- percent)
Total	2,215,000	100.0	0.0000	0.0
Never	215,000	9.7	0.5681	1.1
1 time	64,000	2.9	0.3069	0.6
2 to 4 times	351,000	15.8	0.7361	1.4
5 to 9 times	314,000	14.2	0.7102	1.4
10 to 14 times	417,000	18.8	0.7909	1.6
15 to 24 times	265,000	12.0	0.6585	1.3
25 to 49 times	193,000	8.7	0.5529	1.1
50 times or more	194,000	8.7	0.5591	1.1
Item nonresponse	202,000	9.1	0.5485	1.1

NOTES: Excludes deaths to persons under 15 years of age and those deaths occurring in South Dakota. Figures may not add to totals due to rounding. Standard errors are estimated using the statistical software package SUDAAN.

SOURCES: NCHS, National Mortality Followback Survey — provisional data, 1993.

Ten percent of the decedents where reported to have used their own or family monies to pay for most of their health care during the last year of life. An additional 46 percent reported Medicare as the principal source which paid for most of their health care.

Number and percent distribution of decedents by source which paid most of medical expenses during the last year of life: United States, 1993

Number of times seen by doctor	Number	Percent	Standard error of percent	95 percent confidence interval (+/- percent)
All sources	2,215,000	100.0	0.0000	0.0
Decedent’s own money or savings	185,000	8.3	0.5714	1.1
Family living with decedent	24,000	1.1	0.1745	0.3
Family not living with decedent	13,000	0.6	0.1426	0.3
Prepaid HMO	84,000	3.8	0.3569	0.7
Blue Cross/Blue Shield	151,000	6.8	0.5112	1.0
Other private health insurance	233,000	10.5	0.6153	1.2
Medicare	1,027,000	46.3	0.9973	2.0
Medicaid	239,000	10.8	0.5731	1.1
VA	60,000	2.7	0.2965	0.6
Worker’s Compensation	5,000	0.2	0.0926	0.2
Another government program	27,000	1.2	0.2151	0.4
Other source	11,000	0.5	0.1273	0.2
No payments	44,000	2.0	0.1863	0.4
Item nonresponse	114,000	5.2	0.4356	0.9

SOURCE: NCHS, National Mortality Followback Survey — provisional data, 1993.