CAPITATION, MANAGED CARE, AND CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Expenditure and utilization patterns of aged Medicare beneficiaries wi th chronic obstructive respiratory disease (COPD) (n = 42,472) were co mpared with all Medicare beneficiaries (n = 1,221,615) using a 5% nati onally representative sample of aged Medicare beneficiaries participat ing in the fee-for-service program in 1992. Per capita expenditures fo r an aged Medicare beneficiary with COPD were 2.4 times the per capita expenditures for all Medicare beneficiaries. The most expensive 10% o f Medicare beneficiaries with COPD accounted for nearly half of total expenditures for this population. Higher comorbidity, as measured by t he Deyo-adapted Charlson index, was associated with higher expenditure s. For Medicare Part B claims, internal medicine accounted for the lar gest portion of physician expenditures (14%). Per capita expenditures for pulmonologists were 7.5 times higher for beneficiaries with COPD c ompared with all Medicare beneficiaries. Results from this study sugge st that there is a subgroup of individuals with COPD who are likely to be very expensive during the year. Additional analytic studies are ne eded to more specifically identify characteristics associated with the se individuals. As more Medicare beneficiaries enroll in managed care and as physicians are increasingly being paid on a capitated basis thi s information will be useful to physicians as they monitor the care pr ovided to patients and assess the financial risks they accept under ca pitation.