Major Gaps in Parkinson's Care for Minorities, Women, Rural Patients

Pauline Anderson

July 24, 2023


About 40% of Medicare beneficiaries with Parkinson's disease (PD) don't see a neurologist in a year, and only 9% visit a movement disorder specialist.


An estimated 90% of Americans with PD are covered by Medicare health insurance, but few studies have examined their healthcare utilization patterns.

Research suggests movement disorder specialists more accurately diagnose PD than neurologists who do not have subspecialty training.

Previous research largely focused on the prevalence of PD among White people, male patients, and urban residents.

The new analysis included 685,116 people with PD who were enrolled in Medicare in 2019 (56.3% male; 85.3% White; and 77.9% older than 70 years).


In 2019, about 60% of Medicare beneficiaries with PD had at least one visit with a neurologist, and 9% had at least one consult with a movement disorder specialist (MDS).

Female patients sought care from specialists at lower rates than male patients. Minority groups received specialty care at significantly lower rates than White patients, and beneficiaries in rural areas were significantly less likely to receive care from an MDS than their urban counterparts (7.2% vs 9.5%).

Although rehabilitative services are recommended for people with PD, only 20.3% of beneficiaries with PD underwent physical therapy, 9.5% received occupational therapy, and 7.5% received speech-language therapy during 2019.

Despite the fact that 52.9% of Medicare beneficiaries with PD have depression and/or anxiety, only 1.8% had at least one clinical psychology visit, and 3.9% had at least one psychiatry visit. Individuals older than 70 were more likely to use therapy services than younger patients.


That nearly 250,000 people (40%) with PD don't access specialist care is "a startling number," the investigators note, adding that PD is "a particularly complex disease to medically manage." Best outcomes are achieved when clinicians with neurology training provide care.


The study was conducted by Caroline Pearson, senior vice president for healthcare strategy, NORC, University of Chicago (and executive director, Peterson Center on Healthcare), and colleagues. It was published in npj Parkinson's Disease.


PD prevalence estimates may be low, given the fact that the data don't capture individuals who didn't seek care from a Medicare provider in 2019. The study didn't assess the amount of time that patients had had PD, which is an important factor to address in subsequent research. The investigators relied on medical claims that were billed for PD and other services, and the billing codes that were used may not have been used correctly.


The study was supported by the Parkinson's Foundation and the Michael J. Fox Foundation.

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