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  1. Fulltext. The impact of payor/provider type on health care use and expenditures among the frail elderly.

    Article - En anglais

    Fulltext.

    Objectives

    This study examined whether health care expenditures and usage by the frail elderly differ under three payor/provider types : Medicare fee for service, Medicare health maintenance organization (HMO), and duala Medicare-Medicaid enrollment.

    Methods

    In-home interviews were conducted among 450 frail elderly patients of a San Diego, Calif, health care system.

    Cost and use data were collected from providers.

    Results

    Analyses revealed no difference in total expenditures between fee-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 fee-service-group.

    Fee-for-service participants were less than half as likely as HMO enrollees to have two or more hospital admissions, but hospital usage rates between those two payor/provider groups did not differ.

    Nor were there payor/provider differences in access to home health care, but HMO home health care users received significantly fewer services than the others.

    Conclusions

    The care provided to these HMO beneficiaries resulted in a combination of restricted home health use and higher multiple hospitalizations.

    This raises compelling questions for future research.

    For the dually enrolled, stronger cost containing may be required.

    Mots-clés Pascal : Dépense, Santé, Utilisation, Service santé, Economie santé, Vieillard, Homme, Etude comparative, Paiement, Assurance maladie, Système santé, Californie, Etats Unis, Amérique du Nord, Amérique, Incapacité, Paiement à l'acte, Prépaiement, Health maintenance organization

    Mots-clés Pascal anglais : Expenditure, Health, Use, Health service, Health economy, Elderly, Human, Comparative study, Payment, Health insurance, Health system, California, United States, North America, America

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0363038

    Code Inist : 002B30A01C. Création : 12/09/1997.