Studies suggested that the wide range of drug plan options and the complexity of
drug benefits in the Medicare Part D program might have discouraged the enrollment in
the Medicare Part D program. This study used the Theory of Planned Behaviors (TPB) as
the theoretical framework to understand pre-Medicare eligible individuals’ decisionmaking
in the context of Medicare Part D enrollment. Specifically, the objective of this
research were (1) to examine correlations between underlying beliefs with attitudes,
subjective norms, and perceived behavioral controls variables in the model of the TPB;
and (2) to evaluate the strengths of paths among attitudes, subjective norms, perceived
behavioral controls, and intentions to enroll in the model of the TPB.
This research included focused interviews, pretest study, pilot study, and main
study. The instrument was established and evaluated in focused interviews, pretest
study, and pilot study. Then a cross-sectional survey design was used in the main study
and data was collected by mailed self-administered surveys. The survey was
administered to a random sample of 1500 pre-Medicare eligible individuals (62-64
years) living in Minnesota. 689 surveys were returned; 556 out of these 689 surveys
were eligible for inclusion criteria. The usable response rate was 40.67%.
Descriptive statistics showed that generally pre-Medicare eligible individuals’
evaluations about Medicare Part D (Average score: 3.25 out of 5); their social pressure
to enroll in Medicare Part D (Average score: 3.26 out of 5), and their perceived
controllability (Average score: 3.34 out of 5) regarding the Medicare Part D enrollment
were positive. In addition, their intention to enroll in Medicare Part D was moderately positive (Average score: 3.33 out of 5). Hierarchical regression analyses were
employed to explore correlations between underlying beliefs (behavioral beliefs,
normative beliefs, and control beliefs) and corresponding factors (attitudes, subjective
norms, and perceived behavioral controls) preceding enrollment intentions. The results
revealed that (1) “saving money on medications” (a=1.79, p<0.0001) was significantly
associated with pre-Medicare eligible individuals’ attitude toward Medicare Part D and
this outcome was perceived significantly beneficial for them. (2) “my spouse/significant
other” (a=1.54, p<0.0001) and “my parents” (a=0.42, p=0.03) were perceived to
approve of Pre-Medicare eligible individuals’ enrollment in Medicare Part D; however,
their motivations to comply with their opinions were not significant; (3) Pre-Medicare
eligible individuals believed that “mailing materials about drug plans” (a=0.4, p=0.0042)
and “consulting with my pharmacy” (a=0.5, p=0.0056) would make is easier for them to
enroll in Medicare Part D.
Structural equation modeling methods (confirmatory factor analysis and path
analysis) were applied to investigate associations between factors (attitudes, subjective
norms, and perceived behavioral controls) analyses and pre-Medicare eligible
individuals’ enrollment intentions. Results showed that (1) attitude (r=0.39 p<0.001)
and subjective norm (r=0.44 p<0.001) were significantly associated with pre-Medicare
eligible individuals’ enrollment intentions in Medicare Part D; (2) subjective norm was
the stronger predictor (r=0.49) than attitudes (r=0.35) of enrollment intentions in
Medicare Part D for male pre-Medicare eligible individuals. However, the difference
was not obvious (r attitude-intention=0.42 vs. r subjective norm-intention=0.40) for female individuals; (3) the TPB model had a reasonable good fit of the data to predict Medicare Part D
enrollment intentions (R2= 0.616).
This study showed that a more favorable evaluation of the Medicare Part D
program, and a stronger perception of relevant others’ beliefs regarding enrolling in
Medicare Part D drug plans could result in a stronger enrollment intentions of pre-
Medicare eligible individuals. This study took the initial step to understand the decisionmaking
process surrounding the Medicare Part D program enrollment in those pre-
Medicare eligible individuals. Based on an understanding of the decision-making process
of the Medicare Part D enrollment, the impact of this study could be enhanced by proving
social support for Medicare beneficiaries in enrolling in Medicare programs. However,
there was considerable variability in the observed association between behavioral
intentions and actual behaviors. Further research is needed to explore the stability
between Medicare Part D enrollment intentions of pre-Medicare eligible individuals and their actual enrollment behaviors. That will be more meaningful.
University of Minnesota Ph.D. dissertation. January 2012. Major: Social and Administrative Pharmacy. Advisors: Richard R. Cline, Ph.D., Ronald S. Hadsall, PhD. 1 computer file (PDF); x, 147 pages, appendices A-E.
The intention to enroll in Medicare Part D:an analysis in the pre-medicare eligible population.
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