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.
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.
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.
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
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0363038
Code Inist : 002B30A01C. Création : 12/09/1997.