THE IMPACT OF PAYOR PROVIDER TYPE ON HEALTH-CARE USE AND EXPENDITURESAMONG THE FRAIL ELDERLY/

Objectives. This study examined whether health care expenditures and u sage by the frail elderly differ under three payor/provider types: Med icare fee for service. Medicare health maintenance organization (HMO), and dual Medicare-Medicaid enrollment. Methods. In-home interviews we re conducted among 450 frail elderly patients of a San Diego, Calif, h ealth care system. Cost and use data were collected from providers. Re sults. Analyses revealed no difference in total expenditures between f ee-for-service and HMO enrollees but Medicare-Medicaid beneficiaries' expenditures were 46.8% higher than those for HMO enrollees and 52.2% higher than those for the fee-for-service group. Fee-for-service parti cipants were less than half as likely as HMO enrollees to have two or more hospital admissions, but hospital usage rates between those two p ayor/provider groups did not differ. Nor were there payor/provider dif ferences in access to home health care, but HMO home health care users received significantly fewer services than the others. Conclusions. T he care provided to these HMO beneficiaries resulted in a combination of restricted home health use and higher multiple hospitalizations. Th is raises compelling questions for future research. For the dually enr olled, stronger cost containment may be required.