DEFINITIONS OF TERMS AND VARIABLES

Transcription

1 B DEFINITIONS OF TERMS AND VARIABLES

2 Health & Health Care of the Medicare Populatio: 2005 Activities of daily livig (ADLs): Activities of daily livig are activities related to persoal care. They iclude bathig or showerig, dressig, gettig i ad out of bed or a chair, usig the toilet, ad eatig. If a sample perso had ay difficulty performig a activity by himself/ herself ad without special equipmet, or did ot perform the activity at all because of health problems, the perso was deemed to have a limitatio i that activity. The limitatio may have bee temporary or chroic at the time of the survey. Sample persos who were admiistered a commuity iterview aswered health status ad fuctioig questios themselves, uless they were uable to do so. A proxy, such as a urse, always aswered questios about the sample perso s health status ad fuctioig for log-term care facility iterviews. Arthritis: The category arthritis icludes rheumatoid arthritis, osteoarthritis, ad other forms of arthritis. Aual rate of chage: The aual rates of chage i Tables 6.1 to 6.16 refer to average aual growth rates. The growth rate from oe year to the ext is the ratio of the figure for the secod year to the figure for the first year, mius 1. The growth rate over a 2-year period is the square root of the ratio of the figure for the third year to the figure for the first year, mius 1. The growth rate over a 3-year period is the cube root of the ratio of the figure for the fourth year to the figure for the first year, mius 1, ad so o. For example, the figure for aual rate of chage from 1992 to 1995 is calculated as follows: the figure for 1995 is divided by the figure for 1992, ad the the cube root of the result is calculated. This figure mius 1 is the average aual growth from 1992 to 1995: / Similarly, the formula used to calculate the average aual growth rate from 1992 to 2005 is: / The aual growth rate from 2004 to 2005 is calculated as follows: (2005 / 2004) 1. The result is the multiplied by 100 to give the percetage preseted i the table. It is ot possible to calculate stadard errors for the growth rates. Balace billig: I the Medicare program, the practice of billig a Medicare beeficiary i excess of Medicare s allowed charge is kow as balace billig. The balace billig amout is the differece betwee Medicare s allowed charge ad the provider s actual charge to the patiet. Capitatio paymet: A capitatio paymet is a predetermied, permember, per-moth paymet from the Medicare program to risk health maiteace orgaizatios (HMOs) (see health maiteace orgaizatio). Risk HMOs use the capitatio paymet to fiace all ecessary Medicare-covered services provided to Medicare beeficiaries erolled i the HMO. The amout paid for each Medicare erollee does ot deped o the actual cost of services provided to the idividual. Chroic coditios: Chroic coditios cosists of heart disease, cacer (other tha ski cacer), Alzheimer s disease/other demetias, metal illess/disorder (depressio/axiety disorders), hypertesio (high blood pressure), diabetes, arthritis, osteoporosis, broke hip, pulmoary disease, stroke, Parkiso s disease, ad uriary icotiece that occurs oce a week or more ofte. I 2003, cacer (other tha ski cacer), Alzheimer s disease/other demetias, ad metal Appedix B Defiitios of Terms ad Variables B-2

3 Health & Health Care of the Medicare Populatio: 2005 illess/disorder (depressio/axiety disorders) were added to the list of chroic coditios. Claim-oly evet: A claim-oly evet is a medical service or evet kow oly through the presece of a Medicare claim. The evet did ot origiate from, ad was ot matched to, a evet or service reported by a sample perso durig a iterview. Coisurace: A coisurace is the percetage of covered hospital or medical expese, after subtractio of ay deductible, for which a isured perso is resposible. For example, after the aual deductible has bee met, Medicare will geerally pay 80 percet of approved charges for services ad supplies covered uder Medicare Part B. The remaiig 20 percet of the approved charge is the coisurace amout, for which the beeficiary is liable. Copaymet: A copaymet is a form of cost-sharig whereby the isured pays a specific amout at the poit of service or use (e.g., $10 per doctor visit). Cost-sharig liability: Cost-sharig is the portio of paymet to a provider of health care services that is the liability of the patiet. Cost-sharig liabilities iclude deductibles, copaymets, coisurace, ad balace billig amouts. Deductible: A deductible is a iitial expese of a specific amout of approved charges for covered services withi a give time period (e.g., $100 per year) payable by a isured perso before the isurer assumes liability for ay additioal costs of covered services. For example, from the first day through the 60th day of a ipatiet hospital stay i 2005, Medicare Part A paid for all covered services except for the first $912. The $912 costituted the ipatiet hospital deductible. Detal service: The basic uit measurig use of detal services is a sigle visit to the detist, at which time a variety of services, icludig cleaig, x-rays, ad a exam, might be redered. Ed-stage real disease (ESRD): Ed-stage real disease is that state of kidey impairmet that is irreversible, caot be cotrolled by coservative maagemet aloe, ad requires dialysis or kidey trasplatatio to maitai life. Fee-for-service paymet: Fee-for-service is a method of payig for medical services i which each service delivered by a provider bears a charge. This charge is paid by the patiet receivig the service or by a isurer o behalf of the patiet. Fuctioal limitatios: Sample persos who reported o limitatios i ay of the activities of daily livig (ADLs) or istrumetal activities of daily livig (IADLs) due to health problems were icluded i the category oe. Sample persos with limitatios i at least oe IADL, but o ADL, were icluded i the category IADL oly. Sample persos with ADL limitatios were categorized by the umber of limitatios (1 to 2, 3 to 5) regardless of the presece or umber of IADL limitatios. Sample persos who were admiistered a commuity iterview aswered questios about their fuctioal limitatios themselves, uless they were uable to do so. A proxy, such as a urse, always aswered questios about the sample perso s fuctioal limitatios for log-term care facility iterviews. Health maiteace orgaizatio (HMO): A HMO provides, or arrages for the provisio of, a comprehesive package of health care services to erolled persos for a fixed capitatio paymet (see cap itatio paymet). The term Medicare HMO icludes all types of HMOs that cotract with Medicare, ecompassig risk HMOs, cost HMOs, ad health care prepaymet plas (HCPPs). Risk HMOs are paid o a capitatio basis to provide Part A ad Part B services to Medicare erollees. Cost HMOs are paid by Medicare o a reasoable Appedix B Defiitios of Terms ad Variables B-3

4 Health & Health Care of the Medicare Populatio: 2005 cost basis to provide Part A ad Part B services to Medicare erollees. HCPPs are paid by Medicare o a reasoable cost basis to provide Part B services to Medicare erollees. Health status: A sample perso was asked to rate his or her geeral health compared to other people of the same age. Sample persos who were admiistered a commuity iterview aswered health status questios themselves, uless they were uable to do so. A proxy, such as a urse, always aswered questios about the sample perso s health status for log-term care facility iterviews. Heart disease: The category heart disease icludes myocardial ifarctio (heart attack), agia pectoris or coroary heart disease, cogestive heart failure, problems with valves i the heart, or problems with rhythm of the heartbeat. Icome: Icome is for caledar year It is for the sample perso, or the sample perso ad spouse if the sample perso was married i All sources of icome from jobs, pesios, Social Security beefits, Railroad Retiremet ad other retiremet icome, Supplemetal Security Icome (SSI), iterest, divideds, ad other icome sources are icluded. This sourcebook categorizes the cotiuous icome variable ito ie icome classes. Ipatiet hospital stay: The basic uit measurig use of ipatiet hospital services is a sigle admissio. Ipatiet hospital expeses iclude charges for a emergecy room visit that resulted i a ipatiet admissio. Ipatiet hospital evets are icluded i the 2005 cost ad use files if the discharge date for the stay was i Istrumetal activities of daily livig (IADLs): Istrumetal activities of daily livig are activities related to idepedet livig. They iclude preparig meals, maagig moey, shoppig for groceries or persoal items, performig light or heavy housework, ad usig a telephoe. If a sample perso had ay difficulty performig a activity by himself/herself, or did ot perform the activity at all, because of health problems, the perso was deemed to have a limitatio i that activity. The limitatio may have bee temporary or chroic at the time of the survey. Sample persos who were admiistered a commuity iterview aswered health status ad fuctioig questios themselves, uless they were uable to do so. A proxy, such as a urse, always aswered questios about the sample perso s health status ad fuctioig for log-term care facility iterviews. Facility iterviewers did ot ask about the sample perso s ability to prepare meals or perform light or heavy housework, sice they are ot applicable to the sample perso s situatio; however, iterviewers did questio proxies about the sample perso s ability to maage moey, shop for groceries or persoal items, or use a telephoe. Isurace coverage: Isurace categories were derived from aual isurace coverage variables i the 2005 Cost ad Use files. The aual variables idicate whether a sample perso held that type of isurace at some poit durig Isurace categories i this sourcebook were costructed to be mutually exclusive by prioritizig isurace holdigs. Medicaid coverage had the highest priority; i.e., if a sample perso was eligible for Medicaid beefits at some poit durig 2005, the perso was icluded i the Medicaid category, regardless of other isurace holdigs durig the year. Erollmet i a Medicare HMO had the secod-highest priority, after Medicaid eligibility. Other public health isurace plas, icludig Veteras Admiistratio eligibility or a State-sposored drug pla, are distributed across the isurace categories accordig to the sample perso s highest-priority isurace coverage. For example, a perso eligible for Medicaid coverage who was also eligible for a State-sposored drug pla is categorized uder Medicaid. The categories defied below apply to commuity residets. Facility residets have oly four isurace categories: Medicare fee-for-serviceoly, Medicaid, private isurace, ad Medicare HMO. No distictio was made durig the collectio of the facility data as to the source of Appedix B Defiitios of Terms ad Variables B-4

5 Health & Health Care of the Medicare Populatio: 2005 a private health isurace pla. The four isurace categories are aalogous to those defied below for commuity residets. For beeficiaries who resided i a log-term care facility for part of the year ad i the commuity for part of the year, commuity isurace status is show. Both types of private isurace ecompasses sample persos eligible for Part A ad/or Part B Medicare beefits, ad who had both employer-sposored private isurace ad self-purchased private isurace, but who did ot have Medicaid or Medicare HMO coverage at ay poit durig Medicare fee-for-service-oly ecompasses sample persos eligible for Part A ad/or Part B Medicare beefits, ad who did ot have Medicaid coverage, private isurace, ad who were ot erolled i a private or Medicare HMO at ay time durig However, sample persos may have had other public isurace coverage, such as a State-sposored prescriptio drug pla, or may have bee eligible for Veteras Admiistratio health care beefits. Medicaid ecompasses sample persos eligible for Part A ad/or Part B Medicare beefits, ad who were eligible for State Medicaid beefits at some poit durig 2005, regardless of the perso s other isurace holdigs. Idividually-purchased private isurace ecompasses sample persos eligible for Part A ad/or Part B Medicare beefits, ad who had self-purchased private isurace plas ( Medigap isurace), but did ot have Medicaid, private or Medicare HMO, or employer-sposored private isurace coverage at ay poit durig Employer-sposored private isurace ecompasses sample persos eligible for Part A ad/or Part B Medicare beefits, ad who had employer-purchased private isurace plas, but did ot have Medicaid, Medicare HMO, or self-purchased private isurace coverage at ay poit durig Sample persos erolled i private HMOs, who did ot have Medicaid or Medicare HMO coverage at ay poit durig 2005, are also icluded i this category. Medicare HMO ecompasses sample persos erolled i ay type of Medicare HMO, who were ot eligible for Medicaid beefits at ay poit durig The category icludes beeficiaries erolled i Medicare risk HMOs, Medicare cost HMOs, ad health care prepaymet plas (see health maiteace orgaizatio). Livig arragemet: For commuity residets, sample persos were separated ito mutually exclusive categories: 1) beeficiary lives aloe, 2) beeficiary lives with a spouse oly, or lives with a spouse ad other relatives or orelatives, 3) beeficiary lives with his or her childre, or lives with his or her childre ad other relatives or orelatives, but does ot live with a spouse, or 4) beeficiary lives with other relatives or orelatives, but ot with his or her childre or a spouse. For beeficiaries who resided i a log-term care facility for part of the year ad i the commuity for part of the year, commuity residece status is show. Log-term care facility: The basic uit measurig use of facility services is a stay i a log-term care facility. Stays are measured i terms of days of residece i that facility. If the beeficiary was still i the facility at the ed of the year, the stay is ot complete, but all data for 2005 are preset. To qualify for the survey, a log-term care facility must have three or more log-term care beds, ad provide either persoal care services to residets, provide cotiuous supervisio of residets, or provide log-term care services throughout the facility or i a separately idetifiable uit. Types of log-term care facilities iclude licesed ursig homes, skilled ursig homes, itermediate care facilities, retiremet homes, domiciliary or persoal care facili- Appedix B Defiitios of Terms ad Variables B-5

6 Health & Health Care of the Medicare Populatio: 2005 ties, distict log-term care uits i a hospital complex, metal health facilities ad ceters, assisted ad foster care homes, ad istitutios for the metally retarded ad developmetally disabled. If oted i foototes, log-term care facility use ad expeditures i this sourcebook iclude short-term facility stays (istitutioal evets), primarily i skilled ursig facilities, that were reported either durig a commuity iterview or created through Medicare claims data. Istitutioal evets are icluded i the 2005 cost ad use files if the discharge date for the stay was i Medicare home health services: Home health care services are arrowly defied i the MCBS public use files. Home health care is limited to skilled ursig services ad other therapeutic services provided by a Medicare participatig home health agecy. I the MCBS, home health use represets evets where medical care, as opposed to persoal care ad support, was furished to the sample perso. Medicare pays 100 percet of the approved cost of covered home health visits, ad 80 percet of the approved cost of durable medical equipmet. Medicare hospice services: Hospice services are arrowly defied i the MCBS public use files. Hospice care is limited to Medicarecovered services for termially ill idividuals who have elected to receive hospice care rather tha stadard Medicare beefits. Hospice services iclude medical, ursig, couselig, ad other supportive services redered to termially ill people ad their families. Hospice care is iteded to be palliative ad to improve quality of life rather tha to cure disease or exted life. Almost all services provided to the hospice beeficiary are fully covered by Medicare. Two exceptios are prescribed medicies ad ipatiet respite care. These two types of services require a small amout of copaymet. Metal illesses/disorders: The category metal illesses/disorders icludes metal retardatio, depressio, ad other metal disorders. This defiitio was expaded to iclude metal retardatio, schizophreia, ad maic depressio for facility residets i 1997; ad it was further expaded to iclude depressio for commuity residets i Missig values: Whe amouts (e.g., beeficiary couts or expeditures per beeficiary) are displayed i a table i this sourcebook, sample persos with missig resposes or who belog to a category of a variable ot show i the table (e.g., other for the variable race/ ethicity ) are excluded from idividual categories displayed, but are icluded i the total. Whe colum or row percetages are displayed i a table, sample persos with missig resposes are assumed to be distributed the same as reported data ad are icluded i the percetages. That is, colum or row percetages sum to 100 percet of the colum or row total. Mobility limitatio: If the sample perso had o difficulty at all walkig a quarter of a mile, the respose was coded as o. If the sample perso had a little, some, or a lot of difficulty, or could ot walk a quarter of a mile, the respose was coded as yes. The respose reflects whether the sample perso usually had trouble walkig, rather tha temporary difficulty, such as from a short-term ijury. Sample persos who were admiistered a commuity iterview aswered health status ad fuctioig questios themselves, uless they were uable to do so. A proxy, such as a urse, always aswered questios about the sample perso s health status ad fuctioig for log-term care facility iterviews. Appedix B Defiitios of Terms ad Variables B-6

7 Health & Health Care of the Medicare Populatio: 2005 Outpatiet hospital services: For a survey-reported evet, the basic uit measurig use of outpatiet services is a separate visit to ay part of a outpatiet departmet or outpatiet cliic at a hospital. For Medicare claim-oly evets, it may represet 1) a sigle visit; 2) multiple procedures or services withi oe visit; or 3) multiple visits billed together. Outpatiet hospital evets iclude emergecy room visits that did ot result i a ipatiet hospital admissio. Persoal health care expeditures: Persoal health care expeditures cosist of health care goods ad services purchased directly by idividuals. They exclude public program admiistratio costs, the et cost of private health isurace, research by oprofit groups ad govermet etities, ad the value of ew costructio put i place for hospitals ad ursig homes. Total persoal health care expeditures i this source-book equal the sum of expeditures by Medicare, Medicaid, private isurace, out-of-pocket, ad other sources, as defied below. Log-term care facility expeditures iclude expeditures for short-term facility stays (istitutioal evets), primarily i skilled ursig facilities, that were reported durig a commuity iterview or created through Medicare claims data as oted i foototes. Medicare expeditures equal Medicare program paymets for fee-for-service beeficiaries, aual capitatio paymets to Medicare HMOs o behalf of erollees, 1 ad pass-through expeses for ipatiet hospital services (see defiitio below). They exclude reported or imputed charges for idividual evets reported by Medicare HMO erollees. Capitatio paymets were allocated across medical service types i the same proportios as Medicare fee-for-service paymets for medical service types. Medicare expeditures for ipatiet hospital services iclude pass-through expeses. Medicare s Prospective Paymet System (PPS) for ipatiet hospital services pays a fixed, predetermied amout per case. However, this paymet excludes some hospital expeses, particularly for capital costs, that are reimbursed o a cost basis (i.e., capital costs are passed through for paymet). I order to calculate total Medicare program paymets (actual PPS case paymet plus the prorated share of pass-through costs), estimated pass-through costs were added to charges for ipatiet hospital evets. Medicare expeditures for log-term care services cosist of paymets made by Medicare to log-term care facilities for skilled ursig or skilled rehabilitatio services that are ot icluded i ay of the other evet records. Medicaid expeditures cosist of paymets for services made by State Medicaid programs. Medicaid covers coisurace amouts, copaymets, deductibles, ad charges for some o- covered services ot paid for by other public or pri- Medicare vate isurace plas. Private isurace expeditures cosist of paymets made by idividually-purchased private isurace plas ad employ- private isurace plas, plus paymets reported er-sposored by or imputed for sample persos erolled i private health maiteace orgaizatios. The defiitio applies to commuity residets ad part-year commuity/part-year facility residets. For facility residets, private isurace expeditures cosist of paymets made by private health isurace plas, whose sources (i.e., idividual purchase or employersposored) are ukow. No distictio was made durig the collectio of the facility data as to the source of private health isurace plas. 1 I this sourcebook, the followig chages were made i calculatig total Medicare HMO expeditures: a) admiistrative cost (about 10 percet of the total aual Medicare HMO capitated paymets) was subtracted from the total aual Medicare HMO capitated paymets; ad b) aual Medicare HMO premiums were added to the total aual Medicare HMO capitated paymets. Appedix B Defiitios of Terms ad Variables B-7

8 Health & Health Care of the Medicare Populatio: 2005 Out-of-pocket expeditures cosist of direct paymets to providers made by the sample perso, or by aother perso o behalf of the sample perso. These paymets are for coisurace amouts, copaymets, deductibles, balace billigs, ad charges for o-medicare covered services ot paid for by public or private isurace plas. Other source expeditures cosist of paymets made by other public health plas ad private liability isurace plas. For sample persos who resided i the commuity, examples of other public sources of paymet iclude State pharmaceutical assistace programs ad paymets for sample persos who received medical services from the Veteras Admiistratio. For sample persos who resided i a log-term care facility, examples of other public sources of paymet iclude paymets from State, couty, or commuity departmets of metal health, State supplemetal assistace ad welfare programs, ad Black Lug fuds. Physicia/supplier services: Physicia/supplier services iclude medi cal doctor, osteopathic doctor, ad health practitioer visits; diagostic laboratory ad radiology services; medical ad surgical services; durable medical equipmet; ad odurable medical supplies. Health practitioers iclude audiologists, optometrists, chiropractors, podiatrists, metal health professioals, therapists, urses, paramedics, ad physicia s assistats. For survey-reported evets, the basic uit measurig use of physicia/supplier services is a separate visit, procedure, service, or purchase of a medical supply or medical equipmet. For Medicare claim-oly evets, it may represet 1) sigle or multiple visits; 2) sigle or multiple procedures; 3) sigle or multiple services; or 4) sigle or multiple supplies, depedig o the umber of items budled together o a sigle bill. Prescriptio medicies: The basic uit measurig use of prescriptio medicies is a sigle purchase of a sigle drug i a sigle cotaier. Prescriptio drug use is collected oly for sample persos livig i the commuity, ad does ot iclude prescriptio medicies admiistered durig a ipatiet hospital stay. Pulmoary disease: The category pulmoary disease icludes emphysema, asthma, ad cardiopulmoary disease. Race/ethicity: Race ad ethic categories were recorded as iterpreted by the respodet. Sample persos who reported they were white ad ot of Hispaic acestry were coded as white o-hispaic; those who reported they were black/africa America ad ot of Hispaic acestry were coded as black o-hispaic; persos who reported they were of Hispaic acestry, regardless of their race, were coded as Hispaic; persos who reported they were America Idia, a Asia or Pacific Islader, or other race ad ot of Hispaic acestry were coded as other race/ethicity. Hispaic icludes persos of Mexica, Puerto Rica, Cuba, Cetral or South America, or other Spaish culture or origi, regardless of race. Begiig i caledar year 1998, sample persos with more tha oe racial backgroud were captured i a separate category ad collapsed ito the other category i the sourcebook. Residece status: Commuity residets are Medicare beeficiaries who lived solely i household uits durig 2005, referred to as commuity settigs i this sourcebook, ad who received commuity iterviews oly. Log-term care facility residets are Medicare beeficiaries who lived solely i a log-term care facility durig 2005 (see log-term care facility), ad who received facility iterviews oly. Part-year commuity/part-year facility residets are Medicare beeficiaries who lived part of the year i the commuity ad part of the year i a log-term care facility, ad who received both commuity ad facility iterviews. Whe part-year commuity/part-year facility residets are icluded i a table, their commuity status is show. Appedix B Defiitios of Terms ad Variables B-8

9 Health & Health Care of the Medicare Populatio: 2005 Satisfactio with care: I sectio 5 of the detailed tables, (Very) Usatisfied icludes a respose of either usatisfied or very usatisfied. Sample persos with resposes of satisfied ad o experiece are ot show i the tables but are icluded i the total populatio, which costitutes the deomiator for calculatig percetages of persos with a give respose. The questios about satisfactio with care represet the respodet s geeral opiio of all medical care received i the year precedig the iterview. Geeral care refers to the sample perso s ratig of the overall quality of medical care received. Of the 10,956 commuityoly residet sample persos represeted i the tables, 6,885 respoded they were satisfied, ad 329 respoded they had o experiece. Follow-up care refers to the sample perso s ratig of followup care received after a iitial treatmet or operatio. Of the 10,956 commuity-oly residet sample persos represeted i the tables, 7,174 respoded they were satisfied, ad 1,133 respoded they had o experiece. Availability refers to the sample perso s ratig of the availability of medical care at ight ad o weekeds. Of the 10,956 commuity-oly residet sample persos represeted i the tables, 4,914 respoded they were satisfied, ad 4,222 respoded they had o experiece. Ease of access to doctor refers to the sample perso s ratig of the ease ad coveiece of gettig to a doctor from her or his residece. Of the 10,956 commuity-oly residet sample persos represeted i the tables, 7,716 respoded they were satisfied, ad 239 respoded they had o experiece. Ca obtai care i same locatio refers to the sample perso s ratig of his or her ability to get all medical care eeds take care of at the same locatio. Of the 10,956 commuityoly residet sample persos represeted i the tables, 6,996 respoded they were satisfied, ad 1,575 respoded they had o experiece. Iformatio from doctor refers to the sample perso s ratig of the iformatio give to the sample perso about what was wrog with him or her. Of the 10,956 commuity-oly residet sample persos represeted i the tables, 7,829 respoded they were satisfied, ad 343 respoded they had o experiece. Doctor s cocer for overall health refers to the sample perso s ratig of the doctor s cocers for her or his overall health rather tha for a isolated symptom or disease. Of the 10,956 commuity-oly residet sample persos represeted i the tables, 7,462 respoded they were satisfied, ad 394 respoded they had o experiece. Cost refers to the sample perso s ratig of the out-of-pocket costs he or she paid for medical care. Of the 10,956 commuity-oly residet sample persos represeted i the tables, 6,926 respoded they were satisfied, ad 310 respoded they had o experiece. Schoolig: Schoolig categories are based o the highest school grade completed. Before caledar year 1998, educatio does ot specify educatio or traiig received i vocatioal, trade, or busiess schools outside of the regular school system. Sice caledar year 1998, educatio or traiig received at these types of istitutios are collapsed ito years of schoolig. Smoker: Smoker categories i this sourcebook are mutually exclusive. Sample persos who had ever smoked were categorized as ever smoked. Sample persos who smoked previously but were ot Appedix B Defiitios of Terms ad Variables B-9

10 Health & Health Care of the Medicare Populatio: 2005 curret smokers were categorized as former smoker. Sample persos who reported they curretly smoked were categorized as curret smoker. Smokig icludes a period of regular smokig of cigarettes or pipes, but does ot iclude use of other forms of tobacco, such as chewig tobacco. Social activity limitatio: If the sample perso respoded that health had ot limited her or his social life i the past moth, the respose was coded as o. If the sample perso respoded that health had limited her or his social life i the past moth some, most, or all of the time, the respose was coded as yes. Limitatios o social life iclude limitatios o visitig with frieds or close relatives, ad reflect the sample perso s experiece over the precedig moth, eve if that experiece was atypical. Sample persos who were admiistered a commuity iterview aswered health status ad fuctioig questios themselves, uless they were uable to do so. A proxy, such as a urse, always aswered questios about the sample perso s health status ad fuctioig for log-term care facility iterviews. Source of paymet: See persoal health care expeditures. Survey-reported evet: A survey-reported evet is a medical service or evet reported by a sample perso durig a iterview. The evet may have bee matched to a Medicare claim, or it may be a surveyoly evet, i which case it was ot matched to a Medicare claim ad is oly kow through the survey. Upper extremity limitatio: If the sample perso had o difficulty at all reachig or extedig his or her arms above shoulder level, ad had o difficulty writig or hadlig ad graspig small objects, the respose was coded as o. If the sample perso had a little, some, or a lot of difficulty with these tasks, or could ot do them at all, the respose was coded as yes. The respose reflects whether the sample perso usually had trouble reachig over her or his head or writig, rather tha temporary difficulty, such as from a short-term ijury. Sample persos who were admiistered a commuity iterview aswered health status ad fuctioig questios themselves, uless they were uable to do so. A proxy, such as a urse, always aswered questios about the sample perso s health status ad fuctioig for log-term care facility iterviews. Uriary icotiece: If the sample perso had lost urie beyod his or her cotrol at least oce durig the past 12 moths, the respose was coded as yes. If the sample perso was o dialysis or had a catheter, the respose was coded as missig. User rate: A user rate is defied as the percetage of beeficiaries with the give characteristics who used at least oe of the relevat services durig caledar year For example, the detal services user rate for persos age 85 or older who had Medicaid coverage is equal to the umber of beeficiaries age 85 or older with Medicaid coverage who had at least oe detal visit i 2005, divided by the total umber of persos age 85 or older with Medicaid coverage. Usual source of care: If the sample perso respoded that he or she did ot have a particular medical perso or cliic where he or she usually wet for care or advice about health, the respose was coded as oe. If the sample perso respoded that he or she did have a usual source of care, the sample perso was questioed about the type of place. Other cliic/health ceter icludes a eighborhood or family health ceter, a freestadig surgical ceter, a rural health cliic, a compay cliic, ay other kid of cliic, a walk-i urget ceter, a home visit from a doctor, care i a Veteras Admiistratio facility, a metal health ceter, or other place ot icluded i the listed categories. Appedix B Defiitios of Terms ad Variables B-10