HOUSE CALLS TO THE ELDERLY - A VANISHING PRACTICE AMONG PHYSICIANS

Background Despite the growth in other home health care services, the number of house calls by physicians has declined dramatically during t his century. We determined the frequency of house calls made by physic ians to elderly U.S. patients in 1993 and analyzed the characteristics of the physicians and patients involved. Methods We analyzed a 5 perc ent random sample of the 1993 Medicare Part B claims data for benefici aries over the age of 65 who were not enrolled in health maintenance o rganizations (HMOs). With supplemental information from the Area Resou rce Pile and the American Medical Association's Physician I Masterfile , we determined how many house; calls were made, their cost, and a num ber of specific characteristics of the physicians and the patients. Re sults In our 1993 sample, 36,350 house calls were made to 11,917 of th e 1,357,262 patients. When extrapolated to all Medicare beneficiaries over age 65 and not enrolled in HMOs, these figures correspond to 727, 000 house calls to 238,340 patients nationwide. We estimated the cost of these house calls to be $63 million. The patients who received hous e calls from physicians were older than those who did not, were more l ikely to die within the calendar year, had higher rates of hospitaliza tion, and were more likely to receive care from other home health prov iders, hospice programs, and skilled-nursing facilities. Patients resi ding in rural areas and those in areas with high physician-to-populati on ratios had an increased likelihood of receiving a house call. The p hysicians who made house calls were more likely than others to be gene ralists, osteopaths, older, male, board-certified, practicing in the N ortheast, and in solo practice. Conclusions A very small percentage (0 .88 percent) of elderly Medicare patients, mainly those who are very s ick and near the end of life, receive house calls from physicians. (C) 1997, Massachusetts Medical Society.