Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Medicare Beneficiary Experiences with 
Home Health Care 
Inspector General 
JULY 2001 
OEI-02-00-00560  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them. This statutory mission is carried out through 
a nationwide program of audits, investigations, inspections, sanctions, and fraud alerts. The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General. It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public. 
The inspection reports provide findings and recommendations on the efficiency, vulnerability, 
and effectiveness of departmental programs. 
OEI's New York Regional Office prepared this report under the direction of John I. Molnar, 
Regional Inspector General, and Renee C. Dunn, Deputy Regional Inspector General. Principal 
OEI staff included: 
REGION  HEADQUARTERS 
Demetra Arapakos, Team Leader
 Tricia Davis, Program Specialist

Miriam Gareau, Lead Analyst
 Brian Ritchie, Director, Technical Support Staff

Patricia Banta 
 Barbara Tedesco, Mathematical Statistician

Thomas Zimmerman

To obtain copies of this report, please call the New York Regional Office at (212) 264-2000. 
Reports are also available on the World Wide Web at our home page address: 
http://www.hhs.gov/oig/oei  E X E C U T I V E  S U M M A R Y  
PURPOSE 
To examine the experiences of Medicare beneficiaries with accessing and receiving home 
health care. 
BACKGROUND 
This inspection is part of a current series of four Office of Inspector General inspections 
about Medicare home health care. Access to Home Health Care After Hospital 
Discharge 2001, OEI-02-01-00180, assesses the effects of the prospective payment 
system on access to home health care for Medicare beneficiaries who are discharged from 
the hospital.  Medicare Home Health Care - Beneficiaries from the Community, OEI-02-
01-00070, looks at access to home health care for Medicare beneficiaries who have not 
recently been in the hospital. We are also conducting a study that examines physician 
practices in prescribing, certifying, and monitoring Medicare home health services. 
Home health services consist of skilled nursing, physical, occupational, and speech 
therapy, as well as social work and home health aide services, all furnished in a patients 
home. Medicare will pay for home health care only if the service is ordered by a 
physician and is reasonable and necessary for the treatment of a homebound patients 
illness or injury. 
After a history of increases in the early 1990's, Medicare home health expenditures have 
dropped since 1998. A number of factors have contributed to the decrease including the 
new payment system created by the Balanced Budget Act of 1997, which changed home 
health agency payment from a cost-based method to a prospective payment system of 
fixed, predetermined rates. 
We combined two methods for this inspection: a beneficiary mail survey of 713 Medicare 
home health beneficiaries who began a new episode of home health care in January 2001 
and follow-up telephone interviews with a sub-sample of 30 beneficiaries. 
FINDINGS 
Beneficiaries are positive about their Medicare home health care 
Virtually all Medicare beneficiaries (93 percent) who began receiving home health care 
in January 2001 are satisfied with their care. Satisfaction levels are high among all 
groups of Medicare recipients. Levels do not differ among beneficiaries with different 
ii
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  diagnoses nor between those living in urban and rural locations. Also, Medicare 
beneficiaries generally report a positive relationship with their home health caregivers. 
Most believe their caregivers treat them well and say they are not concerned for their 
safety when workers are in their homes. Just a few beneficiaries (four percent) report 
concerns about the quality or adequacy of their home health care. They report such 
problems as missed appointments or a lack of consistency among home health workers. 
Medicare beneficiaries report almost no difficulty gaining access to care 
Almost none of the Medicare beneficiaries who began a new episode of home health 
care in January 2001 experienced problems accessing care. In fact, only 13 of 501 
respondents report any access problems. Nearly all of these 13 respondents were not in 
the hospital immediately before beginning home health care. About half of them had 
difficulty finding a home health agency and the other half report that they were refused 
by an agency. Our study, however, only includes those Medicare beneficiaries who 
successfully obtained home health care. We are not able to report on the experiences of 
those who were unable to obtain any home health services. 
Although only a few had access problems, almost half of all beneficiaries say that they 
did not have multiple agencies to choose from. They also report that their personal 
involvement in planning for their own care is limited.  They say it is their doctor who 
makes most of the decisions about their care. 
Some beneficiaries would like more services 
Twenty percent of beneficiaries believe they are not receiving all of the services they 
need. They fall into three categories: 1) those who are no longer receiving any home 
health services but believe they still need care; 2) those who want more of a specific 
service they are already receiving; and 3) those who want a specific service they are not 
currently receiving. These beneficiaries most often request home health aide services or 
physical therapy. 
Not all of the home health services beneficiaries want are covered by Medicare. For 
example, beneficiaries are not eligible for Medicare home health aide services unless 
they are also receiving a skilled service, such as skilled nursing or physical therapy. 
Some beneficiaries request more aide services to help with bathing, feeding, or household 
chores. If this is their only care need, they are not eligible for aide services under the 
Medicare benefit. Also, Medicare only covers home health care when the service is 
medically necessary. Therefore, beneficiaries such as one woman who wants more 
physical therapy for palliative care may not be eligible for Medicare coverage of the 
therapy. 
iiii
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  CONCLUSION 
As the Office of Inspector General continues to monitor the Medicare home health care 
program after the implementation of the prospective payment system, it is noteworthy 
that Medicare beneficiaries are pleased with their care. Beneficiaries who entered care in 
January 2001 report positive experiences both accessing and receiving Medicare home 
health services. As noted earlier we are currently preparing three other reports that 
examine beneficiary access to care and the role of the physician in home health care. 
iiiiii
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  T A B L E  O F  C O N T E N T S  
PAGE

EXECUTIVE SUMMARY .................................................. i

INTRODUCTION  .........................................................  1

FINDINGS 
Beneficiaries are positive about their home health  .............................. 5

Beneficiaries report almost no difficulty gaining access .......................... 7

Some beneficiaries would like more services  .................................. 8

CONCLUSION  ...........................................................  9

APPENDICES

A: Recent Office of Inspector General home health inspections  .................. 10

B: Confidence interval for key variables ..................................... 11

C: Non-respondent analysis ............................................... 12

iivv
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  I N T R O D U C T I O N  
PURPOSE 
To examine the experiences of Medicare beneficiaries with accessing and receiving home 
health care. 
BACKGROUND 
This inspection is part of a current series of four Office of Inspector General inspections 
about Medicare home health care. Access to Home Health Care After Hospital 
Discharge 2001, OEI-02-01-00180, assesses the effects of the prospective payment 
system on access to home health care for Medicare beneficiaries who are discharged from 
the hospital.  Medicare Home Health Care - Beneficiaries from the Community, OEI-02-
01-00070, looks at access to home health care for Medicare beneficiaries who have not 
recently been in the hospital. We are also conducting a study that examines physician 
practices in prescribing, certifying, and monitoring Medicare home health services. See 
Appendix A for a list of other recent OIG reports relating to home health care. 
Medicare Home Health Care 
Home health services consist of part-time or intermittent skilled nursing, physical, 
occupational, and speech therapy, and certain related services, including social work and 
home health aide services, all furnished in a patients home. Services are typically 
provided by registered nurses, therapists, social workers, or home health aides employed 
by or under contract with a home health agency. These agencies can be freestanding or 
hospital-based and are classified as not-for-profit, proprietary, or governmental. 
Medicare will pay for home health care only if the service and the beneficiary meet 
certain criteria. The services must be ordered by a physician and be reasonable and 
necessary for the treatment of the patients illness or injury. Further, the beneficiary must 
be eligible for Medicare coverage of home health services. In order to be eligible, a 
beneficiary must be homebound, under the care of a physician who has established a plan 
of care, and need at least one of the following intermittent skilled services: skilled 
nursing care, physical therapy, speech language pathology, or continued occupational 
therapy. At the start of care occupational therapy alone does not constitute a skilled 
need; however, after care has begun and other skilled services are discontinued, 
continued occupational therapy is a skilled need. There are no specific limits on the 
number of visits or length of coverage and no co-payments or deductibles. 
11
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  A beneficiary is considered homebound when leaving home requires a considerable and 
taxing effort. The Benefits Improvement and Protection Act of 2000 (BIPA) clarified the 
definition, stating that a person can leave his or her home for certain purposes such as 
attending adult day care activities or religious services and still qualify for Medicare 
home health services. 
Trends in Medicare Home Health Care 
After a history of increases, Medicare home health expenditures have dropped since 
1998. Between fiscal years 1991 and 1997, home health care annual expenditures rose 
from $4.7 billion1 to $17.6 billion.2  This was due to an increase in both number of 
beneficiaries receiving home health services and the number of visits they received. In 
1998, however, spending for home health services began to drop and in fiscal year 1999 
was $8.7 billion.3 
A number of factors have contributed to the recent decrease in Medicare home health 
spending. These include the prospective payment limits created by the Balanced Budget 
Act of 1997 (BBA) as well as several initiatives that were implemented in response to 
concerns about fraud and abuse. Specifically, the Health Insurance Portability and 
Accountability Act substantially increased financial support to control fraud and abuse by 
home health agencies. 
Prospective Payment System 
The Balanced Budget Act of 1997 changed the way Medicare pays for home health care. 
The law requires a payment change from a cost-based method to a prospective payment 
system (PPS) of fixed, predetermined rates for home health services. The new 
prospective payment system went into effect nationally on October 1, 2000. Before PPS 
was implemented home health agencies were reimbursed under an interim payment 
system (IPS) beginning in October 1997. 
Under PPS, home health agency payments are based on a 60-day episode that is adjusted 
according to case-mix. The case-mix is based on data elements from the patients 
medical assessment (Outcome and Assessment Information Set) and the projected 
number of therapy hours. The data elements capture information about the patients 
clinical severity, functional severity and service utilization. 
Generally, agencies will receive two payments for each episode. They receive the first 
payment at the beginning of the episode, after they submit a Request for Anticipated 
1  1992 HCFA Statistics, U.S. Department of Health and Human Services 
2  1998 HCFA Statistics, U.S. Department of Health and Human Services 
3  Health Care Financing Administration, U.S. Department of Health and Human Services 
22
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  Payment (RAP), and the second payment when they submit a claim at the end of the 
episode. The RAP contains a code that represents the payment category, or Home Health 
Resource Group (HHRG), of the beneficiarys episode. The claim includes line-item 
detailing of the services the agency provided. 
METHODOLOGY 
We combined two methods for this inspection: a beneficiary mail survey and follow-up 
telephone interviews. 
Sample Selection 
Using the Health Care Financing Administration National Claims History File, we 
selected a simple random sample of 713 Medicare home health beneficiaries. Thirteen of 
these were not useable because of bad addresses. Our universe included all Medicare 
beneficiaries who: 
C  started a new episode of home health care between January 7 and 
January 13, 2001 and 
C  had a RAP submitted to HCFA by January 31, 2001. 
We excluded from the universe beneficiaries who were deceased or resided in Guam and 
Puerto Rico. We defined a new home health episode as any episode where the date of the 
admission on the RAP was the same as the first date of service. This does not include 
episodes that renew services for the same diagnosis. The sample includes beneficiaries 
with a hospital stay immediately prior to starting home health care and those coming 
from the community without a hospital stay. 
Beneficiary Mail Survey 
We sent a self-administered mail questionnaire to the 700 sample beneficiaries with a 
usable address. We also sent pre-notification letters, follow-up postcards, and, to non-
respondents, a second questionnaire. We encouraged our sample beneficiaries to ask for 
the assistance of a family member or friend in filling out the questionnaire. Six 
beneficiaries completed the survey over the telephone with OIG staff. 
Beneficiaries responded to the questionnaire during March and April, 2001. 
Approximately two-thirds of the respondents had completed their most recent home 
health episode at the time of the survey. 
We received 530 responses, for a response rate of 74 percent. Of the 530: 
C  501 beneficiaries completed the survey and indicated that they had received home 
health care; 
33
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  C	 29 indicated that they had not received any home health care since January 1, 
2001. 
We did not consider these 29 in our analysis of the survey data. We plan to follow-up 
with these beneficiaries after the final claims for this time period are available. 
Follow-up Telephone Interviews 
In addition, we conducted follow-up telephone interviews with a purposive sub-sample of 
30 beneficiaries. These 30 beneficiaries were selected because their responses to the 
questionnaire indicated some problems with the care they received. Specifically, they 
either had difficulty accessing or receiving care. During the follow-up interviews we 
spoke to either the beneficiaries or family members about their concerns. 
Limitations 
There are two limitations to our methodology. First, we pulled our sample from RAPs 
rather than final claims in order to minimize the length of time between when the 
beneficiary started care and completed the survey. However, a RAP requests anticipated 
payment for services the agency plans to provide in the future. It is not a claim for 
services already provided. Consequently, our sample may have included some 
beneficiaries who did not actually receive home health services in January. Second, our 
sample included only beneficiaries who were accepted as a patient by a home health 
agency. Therefore, we are not able to report on the experiences of beneficiaries who 
were never able to obtain home health care. 
This inspection was conducted in accordance with the Quality Standards for 
Inspections issued by the Presidents Council on Integrity and Efficiency. 
44
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  F I N D I N G S
Beneficiaries are positive about their Medicare home health care
Ninety-three percent are satisfied with their home health care 
Virtually all Medicare beneficiaries (93 percent) who began receiving home health care
in January 2001 are satisfied with their care.  In fact, 79 percent are very satisfied.  (See
Graph 1 below.)
Graph 1
Medicare Beneficiary Satisfaction
with Home Health Care
Source: Home health beneficiary survey, 2001
Satisfaction is high among all groups of Medicare home health recipients.  Satisfaction
levels do not differ among beneficiaries with different diagnoses nor between those living
in urban and rural locations.  Also, beneficiaries discharged from the hospital prior to
starting home health care and those directly coming from the community are equally
satisfied, as are beneficiaries both with and without a prior home health experience. 
55
Medicare Beneficiary Experiences with Home Health                                                                                           OEI-02-00-00560 Most beneficiaries report the care they are receiving in 2001 compares favorably to care 
they have received in past years. More than half of beneficiaries had Medicare home 
health care prior to their current episode. Most (85 percent) rate their current services 
about the same or better than their prior services. 
Furthermore, many beneficiaries report being grateful for the services they receive. 
Almost one quarter volunteer complementary comments about their home health care. 
One beneficiary writes, I sincerely appreciate the help that I received from this Medicare 
program. Another comments, I could never have managed without the home health 
care, since I live alone. 
Beneficiaries generally have good relationships with their caregivers 
Medicare beneficiaries generally report a positive relationship with their home health 
caregivers. Most (95 percent) believe that their home health workers treat them well, and 
just as many say they have no concern for their personal safety or for the safety of their 
property when these workers are in their home. Also, several beneficiaries praise the 
caring attitude and skill of their caregivers. One beneficiarys family member writes, 
We have only the highest regard for the persons who visited our father. Each person 
was professional, friendly, helpful and sympathetic to our needs. Another writes that 
the therapist taught me to do my therapy. She helps me and makes sure I do it correctly. 
[She is] pleasant, personable, and professional. 
Just a few report concerns about the quality or adequacy of their care 
Four percent of beneficiaries are concerned about the quality or adequacy of their home 
health care. These few respondents express various concerns. Most commonly, they 
report that their home health worker either misses or is late for appointments. Others in 
this group say that the agency is not providing the services that were ordered. Lastly, a 
few say that their Medicare home health services stopped abruptly while they believe 
they still needed care. During follow-up telephone interviews, one says, The doctor said 
I needed [care] for four months and I only got it for one. 
Several beneficiaries also express concern about the lack of consistency among their 
home health workers. For example, the wife of one beneficiary says that it is physically 
taxing for her to train each new home health worker about her husbands special needs 
and every other week it was someone different. In fact, about one third of all 
beneficiaries receiving skilled nursing care say that the same nurse does not usually visit 
each time. Similarly, twenty percent say the same about their home health aides. 
A small number of beneficiaries (four percent) report having made formal complaints in 
the past about their concerns. They made almost half of these complaints to their home 
health agency. Most complaints were specifically about their home health workers. 
Only about one third of these beneficiaries report that they are satisfied with the way 
their complaint was resolved. 
66
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  Finally, a small number of beneficiaries (five percent) with prior home health experience 
say the care they are receiving now is worse than past care; they cite problems with the 
quality or frequency of services. Some say that their home health caregivers did a better 
job in past years, while others report that in the past they obtained more home health 
services, such as a greater number of nursing and aide visits. 
Medicare beneficiaries report almost no difficulty gaining access to 
care 
Very few beneficiaries report access problems 
Almost none of the Medicare beneficiaries who began a new episode of home health 
care in January 2001 experienced problems accessing care. In fact, only 13 of 501 
respondents, most of whom did not have a hospital stay before beginning care, report any 
access problems. About half of these 13 say they had difficulty finding an agency. The 
other half say they were refused by an agency. Some of these problems appear to be 
related to the complexity of the patients care. For example, one writes that her care is 
complicated and most agencies dont want me. Beneficiaries also attribute access 
problems to inadequate agency staffing levels. In a telephone interview, another says she 
had access difficulty because the agency did not have the staff to do wound care. 
Although very few are having difficulty finding a home health agency, almost half of all 
beneficiaries report that they do not have more than one agency to choose from. In fact, 
only one third of beneficiaries discharged from the hospital had a choice of agency. 
Nevertheless, almost all of those who were able to choose an agency are receiving care 
from their first choice.  Medicare requires that hospitals provide all beneficiaries with a 
choice of home health agencies; we do not know if these beneficiaries do not report a 
choice because they were not given one, there is only one agency in their area, or for 
some other reason . 
Beneficiaries involvement in planning for care is limited 
Beneficiaries receive help in planning for their home health care. Over one quarter report 
not being involved at all in the planning for their home health care, and about 40 percent 
say they were only somewhat involved. Only one in ten report that they were able to find 
and choose a home health agency without help. 
Most beneficiaries report that it is their doctor who makes most of the decisions about 
their care. In fact, 79 percent say that it is their doctor, rather than their family or social 
worker, who decided when they needed home health care. Most beneficiaries (54 
percent) also find out about their home health agency from their doctor, rather than from 
someone they know or the hospital discharge planner. In addition, when beneficiaries 
have to choose between two or more agencies, they most commonly get help from their 
doctor. 
77
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  Some beneficiaries would like more services 
Twenty percent of beneficiaries believe they are not receiving all of the services 
they need 
Beneficiaries who believe they are not getting all of the home health care that they need 
fall into three categories: 1) those who are no longer receiving any home health services 
but believe they still need care; 2) those who want more of a specific service they are 
already receiving; and 3) those who want a specific service they are not currently 
receiving. Overall, these beneficiaries request home health aide services most frequently, 
followed by physical therapy. Some beneficiaries report needing specific care, such as a 
nurse to check blood sugar levels or additional weeks of physical therapy. Other 
beneficiaries needs are more general, such as needing more help for activities like 
bathing or household chores. 
However, not all of these services are covered by Medicare 
Not all of the home health aide services beneficiaries want are covered by Medicare. 
Medicare only covers an aide when the patient is also receiving a skilled service, such as 
skilled nursing or physical therapy. Without one of these needs, Medicare does not cover 
an aide to help with personal care. In several of our telephone interviews, beneficiaries 
request more aide services to help with bathing, feeding, or household chores. If this is 
their only care need, they are not eligible for aide services under the Medicare benefit. 
Further, Medicare only covers home health care when the service is medically necessary. 
For example, physical therapy is considered medically necessary only when the therapist 
is either teaching the patient a maintenance program or the patient has rehabilitation 
goals that can be reached in a predictable period of time. Therefore, beneficiaries such as 
one woman who wants more physical therapy for palliative care because she is still in 
pain may not be eligible for Medicare coverage of the therapy. 
A few beneficiaries express discontent with the Medicare home health benefit. For 
example, the daughter of one beneficiary writes,  because a patient has Alzheimers 
Disease but no other health conditions that require skilled nursing, does not mean that 
home health aides are not necessary. Another says that she needed more physical 
therapy but it had stopped because she wasnt progressing the way (she) should. 
Several other beneficiaries comment that they need help to pay for their medications and 
other personal products, such as incontinent pads, neither of which are covered by 
Medicare. 
88
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  C O N C L U S I O N  
As the Office of Inspector General continues to monitor the Medicare home health care 
program after the implementation of the prospective payment system, it is noteworthy 
that Medicare beneficiaries are pleased with their care. Beneficiaries who entered care in 
January 2001 report positive experiences both accessing and receiving Medicare home 
health services. As noted earlier we are currently preparing three other reports that 
examine beneficiary access to care and the role of the physician in home health care. 
99
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  APPENDIX A 
Recent Office of Inspector General

Home Health Inspections

Office of Inspector General, US Department of Health and Human Services, Medicare 
Beneficiary Access to Home Health Agencies: 2000, OEI-02-00-00320, September 
2000. 
Office of Inspector General, US Department of Health and Human Services, Adequacy 
of Home Health Services: Hospital Readmission and Emergency Room Visits, OEI-02-
99-00531, September 2000. 
Office of Inspector General, US Department of Health and Human Services,  Medicare 
Home Health Agency Survey and Certification Deficiencies, OEI-02-99-00532, 
September 2000. 
Office of Inspector General, US Department of Health and Human Services, Medicare 
Beneficiary Access to Home Health Agencies, OEI-02-99-00530, October 1999. 
1100
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  APPENDIX B 
Confidence Intervals for Key Variables 
We calculated confidence intervals for nine key variables. The point estimate and 95% 
confidence interval are given for each of the following: 
Key Variables  Point  Confidence 
Estimate  Interval 
Medicare home health beneficiaries who are satisfied with 
their care 
Very satisfied  79%  +/- 3.5 
Somewhat satisfied  14%  +/- 3.1 
Beneficiaries who believe that their home health workers 
treat them well  95%  +/- 1.9 
Beneficiaries who are concerned about the quality of their 
home health care  4%  +/- 1.9 
Beneficiaries who say that they had no difficulty finding an 
agency to accept them as a patient.  93%  +/- 1.9 
Beneficiaries who report they were not refused by an 
agency  85%  +/-3.1 
Beneficiaries who do not have more than one agency to 
choose from  46%  +/- 4.4 
Beneficiaries who report that their doctor decided they 
needed home health care  81%  +/- 3.5 
Beneficiaries who report not being involved in the planning 
for their home health care  29%  +/- 4.0 
Beneficiaries who believe they are not getting all of the 
home health care that they need  20%  +/- 3.5 
1111
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  APPENDIX C 
Non-Respondent Analysis 
We tested for the presence of any non-response bias in our survey results. For this 
inspection, the non-respondents are the 183 sample beneficiaries from whom we did not 
receive a completed questionnaire. From our sample of 713, we received a total of 530 
responses. Of these, 501 beneficiaries indicated they had received services. We consider 
these beneficiaries respondents. The other 29 beneficiaries indicated that they had not 
received services. We excluded these 29 from this analysis. 
We used a Chi-Square test to compare our respondents and non-respondents on key 
demographic variables.  These variables were gender, race4, and urban/rural location.5 
In order for the results to be statistically significant at the 95 percent confidence level, the 
Chi-square value must be higher than 3.84 with 1 degree of freedom. The results of the 
Chi-square analysis are presented in Tables A, B, and C. 
Table A shows no statistically significant differences between respondents and non-
respondents for gender. The table also includes the response rates for both males and 
females. 
Table B, however, show a statistically significant difference between respondents and 
non-respondents for race. In order to test whether this difference introduced bias, we 
conducted further analysis on the difference between the race variable for two key survey 
questions. Assuming the non-respondents and respondents from the same group of 
beneficiaries responded to the two key questions at the same rate, we calculated a 
hypothetical point estimate for these two questions for all beneficiaries. This calculation 
gave hypothetical point estimates that were the same as the estimates reported. Seventy-
nine percent of beneficiaries said they are very satisfied with their home health care, and 
20 percent say they are not getting all the services they need. 
Table C shows a statistically significant difference between respondents and non-
respondents for urban and rural location. We conducted the same analysis as described 
above for the urban/rural variable. The estimate for the percentage of beneficiaries who 
are very satisfied with their care is slightly lower - 78 percent as opposed to 79 percent. 
The new estimate on the percentage who say they are not getting all the services they 
4  We divided race into two categories, white and non-white, in order to assure that 
the numbers in each cell would large enough for meaningful comparisons. 
5	 We assigned beneficiaries urban/rural status based on the zip code of their 
mailing address and the 1990 Census data. 
1122
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  need is higher - 21 percent rather than 20 percent. These differences are not statistically 
significant. 
Given the results f this analysis, we believe that the inspection findings accurately 
represent the experiences of the Medicare beneficiaries in our sample. We therefore 
believe that our survey findings can be generalized to the universe of beneficiaries who 
began receiving Medicare home health services in January, 2001. 
Table A 
GENDER BY RESPONSE 
Non-
Respondents  respondents  Total  Response rate 
Male  194  (39%)  56  (31%)  250  77% 
Female  307  (61%)  127  (69%)  434  71% 
Total  501  183  684  73% 
Chi-square = 3.8123 
Degree of freedom = 1 
Table B 
RACE BY RESPONSE 
Non-
Respondents  respondents  Total*  Response rate 
White  438  (88%)  142  (77%)  580  76% 
Other  60  (12%)  40  (23%)  100  60% 
Total  498  182  680  73% 
Chi-square = 10.4777 
Degree of freedom = 1  * No race reported for 4 beneficiaries 
1133
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560  Table C 
URBAN/RURAL BY RESPONSE 
Non-
Respondents  respondents  Total*  Response rate 
Rural  143  (30%)  32  (21%)  162  88% 
Urban  328  (70%)  130  (79%)  471  70% 
Total  471  162  633  74% 
Chi-square = 6.7810 
Degree of freedom = 1  *No urban/rural designation for 51 
1144
Medicare Beneficiary Experiences with Home Health   OEI-02-00-00560