B. Experton et al., THE IMPACT OF PAYOR PROVIDER TYPE ON HEALTH-CARE USE AND EXPENDITURESAMONG THE FRAIL ELDERLY/, American journal of public health, 87(2), 1997, pp. 210-216
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.