When the U.S. Department of Health and Human Services wanted to know why so few people over age 65 were utilizing the free health care provided for them under the Medicare program, Prof. Donald Shepard (Heller) took up the challenge.Shepard and a team of 12 colleagues, including 10 from Brandeis, such asProfs. Jeffrey Prottas, Jose Suaya andWilliam Stason from the Heller School for Social Policy and Management, worked for seven years on a research program sponsored by the Centers for Medicare and Medicaid Services that explored the cost benefit and effectiveness of Medicare.

The study began in 2000 and culminated with his presentation at a conference hosted by the American Association of Cardiovascular and Pulmonary Rehabilitation from Oct. 18 to 21 and the publishing of the paper.

Shepard studied a Medicare program called Cardiac Rehabilitation to see if the program was beneficial to people suffering from heart disease. The program combines various changes in lifestyle that improve the patients' condition post-heart trauma, he said.

To determine the cost effectiveness of the program, Shepard used an equation that looked at the costs, from 1997, of CR per patient receiving Medicare benefits and the net improvement of every year of good health they experienced after the program.

The group found that the net cost, for figures used from 1997, was $11,181 paid by Medicare, while the average net improvement was 1.15 years, Shepard explained. When these terms were divided, he said, the cost effectiveness came to $10,300 per year of life saved.

The accepted value used as a threshold of effectiveness is $50,000, so a 2003 evaluation that found that the cost-effectiveness of the program has increased, to $6,109 per year of life saved, shows how beneficial the program is, Shepard said.

Cost effectiveness is defined by the quality of the care and the cost of the care, Shepard said. Despite the benefits of the program, studies show that in 2001, approximately 13.9 percent of heart patients over 65 used this service.

CR is effective in prolonging survival and reducing disability in patients with coronary heart disease, Shepard said.

In the group's next research step, Prof. Jose A. Suaya (Heller) led colleagues in constructing a map looking at the demographics of people who sought out CR programs, Shepard explained, and then rated each U.S. state, statistically correcting for factors such as age, gender and facilities.

Shepard said there were variations in the use of CR across states, suggesting important variations in attitudes of physicians, patients and Medicare officers.

"We found that overall, those who need it most use it less," said Moaven Razavi, a Heller Ph.D. candidate who participated in the statistical analysis of the research.

Razavi discovered disparities in the social classes of those who received CR versus those who didn't. His research, mostly done through surveys and simulations, found that most who received it were better-educated, owned homes, were more likely to have a spouse and were less likely to have a history of smoking.

"Our theory was that the introduction of new technology increases the gap between the poor and the rich, the insured and the uninsured," he said.

The study shows that that some beneficial interventions increase disparities due to slower uptake by certain populations, according to a poster from the research.

Razavi explained that the Lifestyle Modification Program Demonstration is a new technology whose utilization is not equal across the social strata.

While the gap exists, it shouldn't affect the utilization of Medicare to the extent that it currently does, Razavi explained, as money isn't a barrier to accessing the benefits of the free program.

"Since All Medicare beneficiaries have insurance, I would have expected higher utilization," Shepard said.