Physicians' perceptions of Congressional priorities to improve care for older adults.
|Abstract:||This study documents physicians' beliefs of inequity in the healthcare system and identifies factors contributing to physicians' perceptions of the importance for Congress to address policies to help families with the cost of caring for elderly disabled relatives. Data were analyzed from a nationally representative randomized sample of 1,901 physicians. Logistic regression was performed to determine the influence of physician's characteristics on their perceptions of the importance for Congress to address policies to help families with the cost of caring for elderly disabled relatives. Physician's perceptions of Congressional priority were associated with perceived inequity in the healthcare system [OR = 1.286, CI = (1.116, 1.482), p<.01]. Racial/ ethnic minority physicians were more likely to perceive importance in helping families with the costs of caring for elderly and disabled family members [OR = 1.653, CI = (1.163, 2.349), p<.01]. Physicians have potential to influence priorities for Congress to address health issues associated with healthcare reform for an increasingly aging population.|
Health care reform
Aged (Political activity)
Aged (Political aspects)
Smith, Matthew Lee
Sosa, Erica T.
Ory, Marcia G.
|Publication:||Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 American Journal of Health Studies ISSN: 1090-0500|
|Issue:||Date: Wntr, 2010 Source Volume: 25 Source Issue: 1|
|Topic:||Event Code: 290 Public affairs|
|Organization:||Government Agency: United States. Congress|
|Geographic:||Geographic Scope: New York Geographic Code: 1U2NY New York|
The American population is aging rapidly. With more than 37 million Americans already over age 65 years (Administration on Aging, 2009; Centers for Disease Control and Prevention & National Center for Health Statistics, 2009), older adults are expected to account for 20% of the United States' population by the year 2030 (Administration on Aging, 2009; U.S. Census Bureau, 2004). In addition to reduced rates of childhood mortality (Olshansky et al., 2005; Schwartz et al., 1995), growth among the senior population is attributed, in part, to the aging of "baby boomers" (Administration on Aging, 2009; Alliance for Aging Research, 2002; Iglehart, 2005; Strunk, Ginsburg, & Banker, 2006) and scientific advancements in medicine (Crimmins & Saito, 2001; Fries, 2002; Goldman et al., 2005; Hessler et al., 2003). Additionally, the emergence and effectiveness of public health programs, laws, and regulations (Centers for Disease Control and Prevention & National Center for Health Statistics, 2009; Gostin, 2007) enable Americans to live longer than ever before, with an improved quality of life (Centers for Disease Control and Prevention, 2009).
GROWING BURDEN AND COSTS OF HEALTH CARE
With individuals over age 85 years representing the fastest growing segment of the aging population, a greater demand for assistance with activities of daily living will emerge in forthcoming years (Ed lund, Lufkin, & Franklin, 2003; MetLife Mature Market Institute, 2002). These resulting increases in health care needs, alongside a diminishing primary care physician workforce (Colwill, Cultice, & Kruse, 2008), are projected to dramatically impact the American healthcare infrastructure, threaten the security of primary healthcare among older adults (Strunk et al., 2006; Yeaworth, 2002), as well as contribute to escalating healthcare costs (Strunk et al., 2006) with ramifications for the national economy (Newhouse, 1992; PriceWaterhouseCoopers, 2006; Rothenberg, 2003). The United States spends more per capita on healthcare than any other nation (Anderson & Frogner, 2008; Nolte & McKee, 2008); however, these expenditures yield health benefits far less than should be expected based on the associated monetary investment (Baicker & Chandra, 2004; Cutler, Rosen, & Vijan, 2006; Davis et al., 2007; Schoen, How, Weinbaum, Craig, & Davis, 2006).
Older adults, often limited by fixed income, confront financial burden due to ensuing costs of new and existing medications, hospitalization, and physician visits (Administration on Aging, 2009; Fortess, Soumerai, McLaughlin, & Ross-Degnan, 2001; Kennedy & Erb, 2002). In 2006, out-of-pocket healthcare costs exceeded $4,600 on average for seniors age 65 and older (Administration on Aging, 2009). As individuals live longer with reduced physical and psychological capacities, their family members are destined to incur prolonged financial obligation for the medical and long-term care costs associated with the burgeoning oldest-old population (Centers for Disease Control and Prevention & National Center for Health Statistics, 2009; Shelton, 2001).
ISSUES IN FAMILY CAREGIVING
As Americans age, the demand for family caregivers will grow substantially. An estimated 20% of the U.S. population provides care for an adult over age 65 years (National Alliance for Caregiving and AARP, 2004), and the number of family caregivers is estimated to increase by 85% from year 2000 to 2050 (Talley & Crews, 2007). Increased reliance on family caregiving has occurred partially in response to changes in healthcare policy, advancements in home care technology, and shortened hospital stays (National Alliance for Caregiving and AARP, 2004). Most older disabled individuals reside at home and rely on family and friends to provide care (Stevenson, 2008); however, in the current economic climate (with thousands becoming unemployed each month) and competing work and family obligations out-of-pocket expenses may deter family caregivers from seeking for and/or utilizing appropriate medical care for elderly disabled family members (Oberlander, 2009). These factors, and the possibility of caring for multiple older family members simultaneously, have given rise to the investigation of the health of caregivers as a contemporary public health concern (Talley & Crews, 2007). Demands to meet the needs of their older disabled family member has been shown to cause caregiver stress, burn-out, and deleterious effects on the health of the caregiver and the older adult (National Alliance for Caregiving and AARP, 2004; Talley & Crews, 2007).
HEALTHCARE REFORM AND PHYSICIAN'S ROLE IN POLICYMAKING
Healthcare reform and the regulation of healthcare costs have earned widespread recognition, become embedded in the national agenda, and become defining platform issues within the current political landscape (A. Burton, Friedenzohn, & Martinez-Vidal, 2007; Holmgren, Davis, Guterman, & Scholl, 2007). Despite contention that health care reform cannot be achieved without attention to long-term care reform (Health Reform Dialogue, 2009; Lake Research Partners, 2009), this issue did not receive sufficient attention during the presidential debates surrounding health care reform in 2008 (Stevenson, 2008).
Physicians have historically assumed a critical role in shaping policy and the healthcare infrastructure in the United States. In addition to being among the original signers of the Declaration of Independence (Gifford, 1976) and founders of the United States Constitution (Jameson, 1983), physicians have served in Congress and were vested in healthcare reform as early as Truman's unveiling of the New Deal (Quadagno, 2005). Despite participating in national debates concerning the adoption and extension of Medicare and healthcare reform (Quadagno, 2005), physicians rarely run for office and primarily focus on lobbying efforts through their professional societies (Landers & Sehgal, 2000). Although their representation has drastically decreased in Congress throughout recent decades (Kraus & Suarez, 2004), physicians maintain the unique ability to offer medical expertise and practical insight to inform policymakers in discussions surrounding healthcare reform and associated federal spending (Kraus & Suarez, 2004; Ortolon, 1997). With announcements from the Obama administration pledging to reduce the federal budget deficit by half by the year 2013, and healthcare reform resurfacing as a priority within the President's national agenda, the potential role of physicians to advise Congress about these crucial reform issues is becoming increasingly important (Oberlander, 2009).
Amidst discussions surrounding healthcare structure and reform (see Hacker, Marmor, Oberlander, Skocpol, and Starr), a growing literature examines physicians' influence on Congress (Gruen, Campbell, & Blumenthal, 2006; Landers & Sehgal, 2000; Quadagno, 2005) and their perceptions of healthcare policy priority (Champlin, 2005; Holmgren et al., 2007; Liao & Arnold, 2006; Murphy, 2004). However, limited research investigates physician's perceptions of policy to address helping families to provide care to older disabled family members. Despite knowing physicians' ability to influence healthcare legislation, more research is needed to understand physicians' current position on healthcare reform issues specific to older adults and their caregivers.
This manuscript empirically depicts physicians' perceptions from a historical context to provide insights into physicians' roles in healthcare reform as it relates to the present economic climate. Under standing physicians' past perceptions of priorities for Congress may be useful to predict current perceptions of physicians. Historical review of physicians' perceptions may additionally highlight the importance of further research efforts in this area, especially considering increasing trends in the aging population, associated healthcare expenditures, and assumed costs to family members when caring for older disabled family members.
The purpose of this study is to characterize physicians' perceptions about elderly healthcare policy priorities for Congress. The study investigated two primary research questions: (1) Do physicians believe helping families with the cost of caring for elderly disabled family members should be an important priority for Congress? (2) Which characteristics of physicians or their practices influence physicians' perceptions that helping families with the cost of caring for elderly disabled family members is an important priority for Congress?
Secondary data from the Henry J. Kaiser Family Foundation's Survey of Physicians were examined. The purpose of the questionnaire was to obtain thoughts and opinions of American physicians pertaining to topics of concern to the medical profession. Physicians were surveyed using an eleven-page paper-based questionnaire consisting of thirty-eight (38) items. Survey instrument items included Likert-type scale, yes/no, and open-ended formats. Physicians were asked to consult their records, if necessary, when completing the questionnaire.
PARTICIPANTS AND PROCEDURES
The mail survey was administered to a nationally representative random sample of 2,608 physicians. The sample was drawn from the American Medical Association's (AMA) Physician Masterfile and Association of American Medical Colleges. Racial/ethnic minority physicians were oversampled. Data were weighted to better reflect the true distribution of physicians in the United States. No incentives were provided to participants. Participation in this study was voluntary and participants could withdraw from the study at any time. Identifying information was not collected from participants, thus anonymity was maintained. This secondary data analysis was approved by the Institutional Review Board at Texas A&M University.
All statistical analyses were conducted using SPSS statistical software (version 14.0). Of the 2,608 instruments returned, only records with complete data for all variables of interest were included in the analyses (n = 1,901). Alpha was set at .05 to determine statistical significance. Spearman's rank correlation coefficients were calculated to identify the direction and strength of ordinally scaled associations between physician-related characteristics and other variables of interest (Spearman, 1904). Logistic regression was used to explain the contribution of physician and physicians' practice characteristics on perceptions of the importance for Congress to help families with the costs of caring for elderly disabled family members.
Explanatory variables considered in the analyses were physician characteristics, physicians' practice characteristics, and physicians' beliefs and behaviors. Physicians' characteristics considered included race/ethnicity, age, and sex. The physician's race/ ethnicity variable was dichotomized into categories of racial/ethnic minority physicians (REMP) or non-Hispanic white physicians (NHWP). REMP included physicians who self-identified as African American, Hispanic, Asian or 'other.' Physician's age was categorized into quartiles. Physicians' practice characteristics included region, setting, percent of white patients, and percent of patients on Medicare. Region included Northeast, Midwest, South, West, or Other. Setting included urban, suburban, small town, or rural. Percent of patients on Medicare and percent of patients that are white were categorized into quartiles. Physicians' beliefs included in analyses were beliefs that the healthcare system treats people unfairly based on whether or not they have insurance, their sex, whether or not they speak English, whether or not they are physically disabled, their education, how much money they have, their sexual orientation, and their race or ethnic background. Physicians rated their beliefs of healthcare-related unfairness as occurring never, rarely, somewhat often, or very often. These eight item values were summed to create a composite Perceived Inequity score (Cronbach's [alpha] = 0.90). Larger scores indicate a higher level of belief that the healthcare system treats people unfairly based on the aforementioned patient characteristics. Physician behaviors included whether or not the physician attended a civic organization meeting or contributed to a political campaign within the previous year.
The key dependent variable for this study was whether physicians perceived helping families with the costs of taking care of their elderly disabled family members to be "Found Important" or "Not Found Important" as priorities for Congress. Physicians' perceptions of the importance for Congress to prioritize this issue was self-reported as being very important, somewhat important, not too important, or not at all important. Responses were recoded and dichotomized into two categories: "Found Important" (i.e., very important and somewhat important) and "Not Found Important" (i.e., not too important and not at all important).
The sample analyzed consisted of 1,901 physicians. The majority of physicians were NHWP (78.6 %), male (80.0%) and age 49 or younger (55.5%). Physicians were evenly distributed across all four regions. Physicians' practices were mostly located in urban (40.4%), suburban (32.6%) and small town (21.6%) settings, with only 5.5% located in rural settings. Descriptive statistics are included in Table 1.
Of the 1,901 physicians, 32.7% and 51.5% of physicians perceived helping families with costs of caring for elderly disabled family members as a very important and somewhat important priority for Congress, respectively. Conversely, 13.9% and 1.9% of physicians perceived this issue as a not too important and not at all important priority for Congress, respectively. Physician's perceived unfairness in the healthcare system based on patient characteristics are described in Table 2. Most physicians (73.5%) believed the healthcare system treats people unfairly based on if the patient has health insurance, whereas only 14.6% of physicians believed people are treated unfairly based on their sex. Table 3 displays bivariate correlations among all variables of interest.
IMPORTANCE OF HELPING FAMILIES WITH THE COSTS OF TAKING CARE OF ELDERLY AND DISABLED FAMILY MEMBERS
This logistic regression model has a Nagelkerke R-square of .06 with [[chi square].sub.18n = 1,901] = 63.31, p<.01. Racial/ethnic minority physicians were more likely than non-Hispanic white physicians to perceive it important for Congress to address helping families with the costs of taking care of elderly disabled family members [OR = 1.653, CI = (1.163, 2.349), p<.01]. Physicians who were more likely to perceive this issue as important also believed the healthcare system treats people unfairly based on patient characteristics [OR = 1.286, CI = (1.116, 1.482), p<.01] and had contributed to a political campaign within the previous year [OR = 1.442, CI = (1.105, 1.882), p<.01]. Older physicians were more likely than their younger counterparts to perceive it important for Congress to address helping families with the costs of taking care of elderly disabled family members [OR = 1.380, CI = (1.057, 1.803), p<.05]. Physicians in the South were less likely than physicians in the Northeast to perceive this issue as important [OR = 0.525, CI = (0.364, 0.756), p<.01]. Practices with a slightly higher percent of patients on Medicare (2nd quartile) were less likely than the lowest quartile to find it important to prioritize helping families with the costs of taking care of elderly disabled family members [OR = 0.657, CI = (0.441, 0.980), p<.05]. These and other predictors are presented in the model in Table 4.
Advances in public health and medicine have contributed to lengthened life expectancies, but also subsequently led to an aging society with an increased prevalence of chronic illness and disability. The rapidly escalating aging population in the United States highlights the urgency and demand for access to quality healthcare and assistance to family members who accept the economic challenges associated with caring for a disabled aging family member. Without adequate support allocated to families supporting older disabled family members, existing quality of life may be compromised for seniors and their families, especially in the current economic turndown where nursing home costs are now averaging more than $131 billion a year (Centers for Medicare & Medicaid Services, 2007; Lake Research Partners, 2009). Previously attained health and healthcare received by family members caring for elderly individuals may decrease because of additional time commitments, stressors, and financial obligations, but unchanged monetary resources.
Physicians are a highly influential group, whose membership organizations are taking an active role in current healthcare reform debates (Health Reform Dialogue, 2009). This study investigated physicians' personal and practice characteristics contributing to differences in perceptions of importance for Congress to address issues impacting the older adults and their families. Findings of this study highlight that REMP were more likely to find importance for Congress to address healthcare issues surrounding aging populations than their NHWP counterparts. These findings may be attributed to cultural beliefs held by members of African American and Hispanic communities concerning the influential and important role assumed by older generations (L. M. Burton, Dilworth-Anderson, & Merriwether-de Vries, 1994; Dilworth-Anderson, 1994). REMP may more closely identify first-hand with the financial obligations and tribulations posed by inflated medical costs associated with caring for their own elderly family members (Gruen et al., 2006). These physicians may be more sensitive to the financial needs of their patient-base.
Physicians over the age of 50 years were more likely to perceive it as important for Congress to address helping families with the costs of caring for older disabled family members, when compared to their younger physician counterparts. Support among older physicians may originate from empathy for their aging patients and identification with the issues confronting aging populations. Further, findings from this study support previous literature of physicians' perceptions of inequity in the healthcare system (Brandeis, Pashos, Henning, & Litwin, 2001; Escarce & McGuire, 2004; Franks, Fiscella, & Meldrum, 2005; O'Malley, Forrest, Feng, & Mandelblatt, 2005; Sangho & Jaeun, 2005; Song, Chang, Manheim, & Dunlop, 2006; van Ryn, Burgess, Malat, & Griffin, 2006). Physician's who believed there to be inequity in the healthcare system also perceived it to be important for Congress to help families with the costs of caring for older disabled family members. These findings may indicate physicians who believe there to be inequities in the healthcare system also see a need for political action to address issues of care and treatment in the healthcare system. These physicians may be more aware of issues afflicting patients of particular demographics and recognize the benefits healthcare reform can provide.
There were limitations associated with this descriptive study. First, this study used self-report cross-sectional data, which may be subject to respondent bias. Second, the overall number of physicians recruited to participate in the survey was not available, thus a response rate could not be calculated from the 2,608 respondents who returned the questionnaire. Third, this questionnaire was not specifically designed to answer the research questions of this study; therefore, items beyond physicians' and physicians' practice characteristics were not included within the questionnaire to explain differences in perceptions concerning Congressional priority. This limitation can also be associated with the relatively small Nagelkerke R-square in the logistic regression model. Fourth, the physician responses were collected prior to the change in presidency and economic crisis--and there may now be a shift in attention to these policy issues given the current emphasis on health care reform in an economy that demands immediate action to prevent the consequences of unfettered growth in health care costs. However, these findings serve as a baseline study for further research in this area.
In the current economic recession, provisions of long-term care are reliant on family giving, out-of-pocket payments, and Medicaid (Stevenson, 2008). With widespread unemployment rates and millions of Americans at risk of losing their health insurance, the existing financial burdens on family members caring for elderly disabled adults and barriers to obtaining healthcare may become exacerbated (Oberlander, 2009). Concerns about sustaining existing subsidized healthcare programs are becoming a reality as more aging Americans reach eligibility for Medicare and unemployment creates more individuals eligible to enroll in Medicare (Marmor, Oberlander, & White, 2009; Oberlander, 2009). To overcome the burden of long-term care costs, health care for the aging needs to be seen as a shared responsibility among individuals, family, and the government. As uninsured and aging populations rise, the costs of healthcare will increase in tandem and fuel debates surrounding healthcare affordability (Kraus & Suarez, 2004). Demands for healthcare reform highlight the need for physician leadership in associated discussions related to federal spending (Iglehart, 2004).
The changing demography and health of the American population warrants considerable investigation into physicians' role in policymaking and advocacy to support care for older disabled adults. The current economic status of the United States makes the burdens of family caregiving even more challenging. More investigation is required to examine physicians' perceptions of the importance for Congressional action on general healthcare reform and reform issues specific to aging adults and their families. To address geriatric healthcare issues in the current healthcare reform debate, physicians are encouraged to actively engage in dialogue to advocate for reform to reduce age-related disparities in healthcare settings. These efforts by physicians can assist families to offset costs associated with long-term care for aging family members in either home or more institutional settings. The policies, programs, and infrastructure influencing the health of aging populations impact more than just the health of older adults. Healthcare subsidies and reform for the aging population, and supporting Congressional legislature, may diminish the inflation of healthcare costs for all Americans and foster quality healthcare for generations to come.
The authors would like to thank the Kaiser Family Foundation for making this study possible. The authors would also like to thank Dr. Dhananjaya Arekere for providing constructive comments and suggestions in regard to this project.
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Matthew Lee Smith, PhD, MPH, CHES, CPP
Erica T. Sosa, PhD
Marcia G. Ory, PhD, MPH
Matthew Lee Smith, PhD, MPH, CHES, CPP, is affiliated with the Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center. Erica T. Sosa, PhD, is affiliated with the Health & Kinesiology Department, The University of Texas at San Antonio. Mareia G. ory, PhD, MPH, is affiliated with the Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center. Please address all correspondence to Matthew Lee Smith, PhD, MPH, CHES, CPP, School of Rural Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX 77843. Tel: 979.845.5788. Fax: 979.862.8371. E-mail: email@example.com
Table 1. Sample Characteristics (n = 1,901) Variables of Interest NHWP (n = 1495) Age Group [less than or 766 (51.2%) equal to] 49 Years 50 Years and Older 729 (48.8%) Sex Female 273 (18.3%) Male 1221 (81.7%) Region Northeast 363 (24.3%) Midwest 328 (21.9%) South 480 (32.1%) West 324 (21.7%) Setting Urban 573 (38.4%) Suburban 508(34.0%) Small Town 331 (22.2%) Rural 82 (5.5%) Percent of White Patients Bottom Quartile 273 (18.3%) 2nd Quartile 393 (26.3%) 3rd Quartile 405 (27.1%) Top Quartile 424 (28.4%) Percent of Patients on Medicare Bottom Quartile 361 (24.1%) 2nd Quartile 301 (20.1%) 3rd Quartile 407 (27.2%) Top Quartile 426 (28.5%) Attended a group or civic organization meeting (previous 12 months) Yes 807 (54.0%) No 688 (46.0%) Donated money to a political campaign (previous 12 months) Yes 622 (41.6%) No 873 (58.4%) Variables of Interest REMP (n = 406) Age Group [less than or 212 (52.2%) equal to] 49 Years 50 Years and Older 194 (47.8%) Sex Female 106 (26.1%) Male 300 (73.9%) Region Northeast 79 (19.4%) Midwest 95 (23.3%) South 139 (34.2%) West 94 (23.1%) Setting Urban 194 (47.8%) Suburban 111 (27.3%) Small Town 79 (19.5%) Rural 22 (5.4%) Percent of White Patients Bottom Quartile 152 (37.4%) 2nd Quartile 105 (25.9%) 3rd Quartile 70 (17.2%) Top Quartile 79 (19.5%) Percent of Patients on Medicare Bottom Quartile 105 (25.9%) 2nd Quartile 78 (19.2%) 3rd Quartile 102 (25.1%) Top Quartile 121 (29.8%) Attended a group or civic organization meeting (previous 12 months) Yes 171 (42.1%) No 235 (57.9%) Donated money to a political campaign (previous 12 months) Yes 153 (37.7%) No 253 (62.3%) Variables of Interest [chi square] Age Group 0.123 [less than or equal to] 49 Years 50 Years and Older Sex 12.274 Female Male Region 4.255 Northeast Midwest South West Setting 12.461 Urban Suburban Small Town Rural Percent of White Patients 74.507 Bottom Quartile 2nd Quartile 3rd Quartile Top Quartile Percent of Patients 1.235 on Medicare Bottom Quartile 2nd Quartile 3rd Quartile Top Quartile Attended a group or civic 17.985 organization meeting (previous 12 months) Yes No Donated money to a political 2.032 campaign (previous 12 months) Yes No Variables of Interest p-value Age Group 0.726 [less than or equal to] 49 Years 50 Years and Older Sex 0.000 Female Male Region 0.235 Northeast Midwest South West Setting 0.006 Urban Suburban Small Town Rural Percent of White Patients 0.000 Bottom Quartile 2nd Quartile 3rd Quartile Top Quartile Percent of Patients 0.745 on Medicare Bottom Quartile 2nd Quartile 3rd Quartile Top Quartile Attended a group or civic 0.000 organization meeting (previous 12 months) Yes No Donated money to a political 0.154 campaign (previous 12 months) Yes No Table 2. Physician Perceived Importance of Helping Families with Costs of Caring for Elderly Disabled Family Members & Perceived Unfairness in the Healthcare System (n = 1,901) Frequency (%) Perceived Importance of: Important Not Important Helping families with cost 1600 (84.2) 301 (15.8) of caring for elderly disabled family members Perceived Unfairness based on: Very/Somewhat Not Too Often Often/Never Whether or not they have health 1397 (73.5) 504 (26.5) insurance Whether they are male or female 278 (14.6) 1623 (85.4) How well they speak English 813 (42.8) 1087 (57.2) Whether or not they are physically 417 (21.9) 1484 (78.1) disabled How well educated they are 718 (37.8) 1183 (62.2) How much money they have 886 (46.6) 1015 (53.4) Their sexual orientation 434 (22.8) 1467 (77.2) Their race or ethnic background 520 (27.3) 1381 (72.7) Table 3. Correlations among variables of interest 1 2 3 4 5 1 1 -0.185 ** -0.084 ** -0.098 ** 0.045 0.000 0.002 0.000 0.104 2 1 0.093 ** 0.041 -0.128 ** 0.001 0.143 0.000 3 1 -0.179 ** 0.019 0.000 0.499 4 1 -0.028 0.316 5 1 6 7 8 9 6 7 8 9 1 0.060 * -0.133 ** -0.024 -0.089 ** 0.029 0.000 0.385 0.001 2 0.038 -0.002 0.099 ** 0.011 0.165 0.938 0.000 0.696 3 0.063 * -0.055 * -0.044 -0.252 ** 0.022 0.047 0.110 0.000 4 -0.175 ** 0.164 ** 0.004 0.117 ** 0.000 0.000 0.891 0.000 5 0.100 ** 0.003 -0.030 0.004 0.000 0.921 0.282 0.884 6 1 -0.155 ** -0.004 -0.058 * 0.000 0.884 0.035 7 1 -0.053 -0.084 ** 0.055 0.002 8 1 0.141 ** 0.000 9 1 1 = Helping with cost of taking care of elderly disabled family members 2 = REMP 3 = Age Groups 4 = Sex 5 = Percent white patients 6 = Percent patients on Medicare 7 = Perceived inequity in the healthcare system 8 = Attended a group or civic organization meeting 9 = Donated money to a political campaign p <. 05 *, p < 0.01 ** Table 4. Hierarchical logistic regression predicting physicians' agreement for Congress to help families with the costs of caring for elderly and disabled family members (n = 1,901) Variables Step 1 B Race Category NHWP 1.000 REMP 0.503 Age Group [less than or 1.000 equal to]49 Years 50 Years and Older 0.322 Sex Male 1.000 Female 0.088 Region Northeast 1.000 Midwest -0.274 South -0.645 West -0.340 Setting Urban 1.000 Suburban 0.045 Small Town 0.025 Rural 0.060 Percent of White Patients Bottom Quartile 1.000 2nd Quartile 0.106 3rd Quartile 0.080 Top Quartile -0.220 Percent of Patients on Medicare Bottom Quartile 1.000 2nd Quartile -0.419 3rd Quartile -0.378 Top Quartile -0.310 Perceived Inequity in the Healthcare System 0.252 Attended civic organization meeting No 1.000 Yes -0.108 Contributed to a political campaign No 1.000 Yes 0.366 Variables Agreement Step 1 OR [CI] Race Category NHWP REMP 1.653 [1.163, 2.349]** Age Group [less than or equal to]49 Years 50 Years and Older 1.380 [1.057, 1.803] * Sex Male Female 1.092 [0.771, 1.547] Region Northeast Midwest 0.760 [0.508, 1.137] South 0.525 [0.364, 0.756] ** West 0.712 [0.474, 1.069] Setting Urban Suburban 1.046 [0.766, 1.428] Small Town 1.025 [0.724, 1.451] Rural 1.062 [0.599, 1.883] Percent of White Patients Bottom Quartile 2nd Quartile 1.111 [0.770, 1.604] 3rd Quartile 1.083 [0.737, 1.592] Top Quartile 0.803 [0.547, 1.178] Percent of Patients on Medicare Bottom Quartile 2nd Quartile 0.657 [0.441, 0.980] * 3rd Quartile 0.685 [0.468, 1.004] Top Quartile 0.733 [0.501, 1.073] Perceived Inequity in the Healthcare System 1.286 [1.116, 1.482] ** Attended civic organization meeting No Yes 0.897 [0.694, 1.160] Contributed to a political campaign No Yes 1.442 [1.105, 1.882] ** p < .05 *, p < 0.01 **
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