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PubMed1985

Out-of-plan use by Medicare enrollees in a risk-sharing health maintenance organization.

In this study, we analyzed the cost and volume effects of a waiver that eliminated lock-in restrictions on out-of-plan use in a health maintenance organization (HMO) with a Medicare risk-sharing contract. We compared out-of-plan cost and number of claims during a 15-month base line period when the lock-in was in effect, with a 24-month waiver period when the lock-in was removed. The results demonstrate that average per capita cost and claims increased significantly for both Medicare Part A (hospital insurance) and Part B (supplementary medical insurance) out-of-plan services during the waiver. Self-referred out-of-plan use normally prohibited by lock-in, accounted for 20 percent of all out-of-plan costs during the waiver and 57 percent of the increase in out-of-plan costs from the lock-in to the waiver. The combination of risk-sharing and lock-in provisions holds promise as a method for reducing expenditures for the Medicare program.

Costs and Cost Analysis↗
PubMed1986

Changes in distribution of Medicare expenditures among aged enrollees, 1969-82.

In this article, we examined the concentration of Medicare expenditures among the aged for 1969, 1975, and 1982 to determine if expenditures have become more concentrated among a few heavy users of service over time. Despite an increase in reimbursements for the aged from $6.0 billion in 1969 to $41.8 billion in 1982, the distribution of those expenses remained remarkably stable, with a slight lessening in the concentration of reimbursements in 1982. Patterns were similar for both Part A (hospital insurance) and Part B (supplementary medical insurance) services. The concentration of expenditures was much greater among survivors than among people who died in both 1975 and 1982, with little change in the distribution of expenditures within either group.

Aged↗
PubMed1987

Outpatient prescription drug utilization and expenditure patterns of noninstitutionalized aged Medicare beneficiaries.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) of 1980 was to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. This report provides data regarding prescription drugs obtained on an outpatient basis by noninstitutionalized elderly people who reported being covered by Medicare in 1980. The results presented are based on NMCUES data collected about the civilian noninstitutionalized persons in the NMCUES national household sample who at any time during the survey year of 1980: (1) were 65 years of age or over, and (2) reported having been covered by Medicare hospital insurance (HI) or Medicare supplementary medical insurance (SMI) or both. These results include the number of prescriptions obtained during the survey year, the total charges for these prescriptions, the amounts paid by various sources, and the types of drugs obtained. Noninstitutionalized aged Medicare beneficiaries obtained an estimated 288 million prescriptions during 1980 and spent an estimated $2.3 billion for prescription drugs. Four of five beneficiaries used prescription drugs during the year. Although aged Medicare beneficiaries represented only 10.9 percent of the U.S. population during 1980, they accounted for 28.6 percent of all prescriptions and 30.2 percent of total prescription drug charges. The average aged beneficiary during the year purchased 12.1 prescriptions and incurred $98 of expenditures, about three times the average of those under 65 years of age. The average charge per prescription was $8.05. Prescription drug charges accounted for 5.5 percent of an estimated $42 billion spent by aged Medicare beneficiaries for health care during 1980, excluding charges for institutional care. Prescription drug use and expenditures were lower among people 65-69 years of age than among people 70-74 or 75-79 years of age. On average, women used more prescriptions and incurred higher charges than did men. Regionally, the average number of prescriptions that were filled per beneficiary was highest in the South and lowest in the West. People who perceived their health status to be poor had approximately four times as many prescriptions filled per person and incurred four times the average annual charge of people who perceived their health status to be excellent. Approximately 68 percent of the total dollars spent by aged Medicare beneficiaries for prescription drugs was paid out-of-pocket, 13.9 percent was paid by private health insurance, and 10.8 percent was paid by Medicaid. The remaining charges were distributed among other payers.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1983

Health status of aged Medicare beneficiaries.

The goal of the National Medical Care Utilization and Expenditure Survey (NMCUES) was to improve the understanding of the ways in which Americans use and pay for health care. This report is one in a series of descriptive reports based on NMCUES data. Data concerning several aspects of participants' health status were collected in NMCUES. These included measures of disability, activity limitation, illness conditions, and perceived health status. The purpose of this report is to provide preliminary descriptive information from NMCUES about selected aspects of the health status of noninstitutionalized elderly people who reported being covered by Medicare. The results presented are based on data collected about noninstitutionalized people in the NMCUES national household sample who: (1) were 65 years of age and over at any time during the survey year, and (2) reported being covered by Medicare Hospital Insurance, Supplementary Medical Insurance, or both during the survey year (1980). Of the aged Medicare beneficiaries, 37 percent reported experiencing no days on which their activities were limited for health reasons during the survey year. The average number of restricted activity days (RAD's) per year per person among all aged Medicare beneficiaries was estimated to be 31. By comparison, people under 65 years of age averaged 12 RAD's. At the beginning of the survey period, 60 percent reported that they were not limited in either their usual activity (e.g., work) or other activities (e.g., recreation) for health reasons. Men were substantially more likely than women to be limited in their activities (52 versus 31 percent). Of persons under 65 years of age, 94 percent reported no activity limitation. Of aged Medicare beneficiaries, 7 percent reported having no illness conditions during the survey year, while 23 percent reported seven or more illness conditions. Only 5 percent reported having one or more illness conditions for which they had not sought medical attention. The average number of conditions per person during the year was 4.4. People under 65 years of age averaged 2.9 illness conditions. The health of more than one-fourth (26 percent) of the elderly Medicare beneficiaries was judged to be excellent relative to other people of the same age, while the health of one out of eight people (12 percent) was judged to be poor.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗