Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

Inspector General 

JULY 2001 

OEI-02-00-00560 

Medicare Beneficiary Experiences with 

Home Health Care 
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 

Demetra Arapakos, Team Leader

Miriam Gareau, Lead Analyst

Patricia Banta 

Thomas Zimmerman

HEADQUARTERS 

Tricia Davis, Program Specialist

Brian Ritchie, Director, Technical Support Staff

Barbara Tedesco, Mathematical Statistician

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 
i

EXECUTIVE SUMMARY 

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 patient’s 

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 patient’s 

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 

Medicare Beneficiary Experiences with Home Health i OEI-02-00-00560 
ii

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. 

Medicare Beneficiary Experiences with Home Health ii OEI-02-00-00560 
iii

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. 

Medicare Beneficiary Experiences with Home Health iii OEI-02-00-00560 
iv

TABLE OF CONTENTS 

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

Medicare Beneficiary Experiences with Home Health iv OEI-02-00-00560 
1

INTRODUCTION 

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 patient’s 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 patient’s 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. 

Medicare Beneficiary Experiences with Home Health 1 OEI-02-00-00560 
2

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 patient’s 

medical assessment (Outcome and Assessment Information Set) and the projected 

number of therapy hours. The data elements capture information about the patient’s 

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 

Medicare Beneficiary Experiences with Home Health 2 OEI-02-00-00560 
3

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 beneficiary’s 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 nonrespondents, 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; 

Medicare Beneficiary Experiences with Home Health 3 OEI-02-00-00560 
4

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 President’s Council on Integrity and Efficiency. 

Medicare Beneficiary Experiences with Home Health 4 OEI-02-00-00560 
Medicare Beneficiary Experiences with Home Health 5 OEI-02-00-00560

FINDINGS

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. 

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. 

levels do not differ among beneficiaries with different diagnoses nor between those living

in urban and rural locations. 

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. 

In fact, 79 percent are very satisfied. (See

Satisfaction

Also, beneficiaries discharged from the hospital prior to
6

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 beneficiary’s 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 husband’s 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. 

Medicare Beneficiary Experiences with Home Health 6 OEI-02-00-00560 
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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 patient’s care. For example, one writes that her “care is 

complicated and most agencies don’t 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. 

Medicare Beneficiary Experiences with Home Health 7 OEI-02-00-00560 
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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 Alzheimer’s 

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 “wasn’t 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. 

Medicare Beneficiary Experiences with Home Health 8 OEI-02-00-00560 
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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. 

Medicare Beneficiary Experiences with Home Health 9 OEI-02-00-00560 
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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. 

Medicare Beneficiary Experiences with Home Health 10 OEI-02-00-00560 
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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 

Estimate 

Confidence 

Interval 

Medicare home health beneficiaries who are satisfied with 

their care 

Very satisfied 

Somewhat satisfied 

79% 

14% 

+/- 3.5 

+/- 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 

Medicare Beneficiary Experiences with Home Health 11 OEI-02-00-00560 
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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 nonrespondents 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. Seventynine 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 nonrespondents 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. 

Medicare Beneficiary Experiences with Home Health 12 OEI-02-00-00560 
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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 

Respondents respondents Total 

NonMale 194 (39%) 56 (31%) 250 

Response rate 

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 

Respondents respondents Total* 

NonWhite 438 (88%) 142 (77%) 580 

Response rate 

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 

Medicare Beneficiary Experiences with Home Health 13 OEI-02-00-00560 
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Table C 

URBAN/RURAL BY RESPONSE 

Respondents respondents Total* 

NonRural 143 (30%) 32 (21%) 162 

Urban 328 (70%) 130 (79%) 471 

Total 471 162 633 

Response rate 

88% 

70% 

74% 

Chi-square = 6.7810 

Degree of freedom = 1 *No urban/rural designation for 51 

Medicare Beneficiary Experiences with Home Health 14 OEI-02-00-00560