title: Transitions in health care use and expenditures among frail older adults by payor/provider type.
abstract: OBJECTIVE
  To assess whether transitions in health care expenditures differed over time by payor/provider type: Medicare fee-for-service (FFS), Medicaid-Medicare, and Medicare HMO.
  
  
  METHODS
  Longitudinal study.
  
  
  METHODS
  A large, nonprofit healthcare system in San Diego, California.
  
  
  METHODS
  A total of 450 frail older people who responded to the baseline and follow-up surveys and who survived the 18-month study period.
  
  
  METHODS
  Measures included three total expenditure categories for each 6-month period: low users (< $4000); medium users ($4000-$19,999); or high users ($20,000+). Seven conceptually meaningful expenditure trajectories over time were identified: (1) consistently low expenditures, (2) consistently medium expenditures, (3) consistently high expenditures, (4) decreasing expenditures, (5) increasing expenditures, (6) U-shaped expenditures, and (7) inverted U-shaped expenditures.
  
  
  RESULTS
  Logistic regression analyses showed that HMO enrollees were about twice as likely as Medicaid-Medicare beneficiaries to have consistently low expenditures, but no differences were found between the FFS and HMO groups on this trajectory. Other expenditure patterns showed no significant differences by payor/provider group. Significant interactions among payor/provider type, low/medium/ high expenditure status, and time were observed for inpatient hospital care, skilled nursing/rehabilitation care, and home health care.
  
  
  CONCLUSIONS
  This study illustrates the complexity of frail older people with respect to their health care expenditures and service use. Expanded efforts to control health care expenditures for frail older people should focus first on those who are dually-enrolled. In addition, because mean medical expenditures for high users enrolled in different payor/ provider groups were surprisingly similar, the data suggest that containing expenditures for individuals in the highest usage group ($20,000+) presents challenges for physicians practicing in an era of healthcare reform, regardless of payor/ provider setting.
authors.affiliation: Brown University, Center for Gerontology and Health Care Research, Ann Arbor, MI, USA.
authors.forename: D N
authors.initials: DN
authors.lastname: Pearlman
authors.forename: L G
authors.initials: LG
authors.lastname: Branch
authors.forename: R J
authors.initials: RJ
authors.lastname: Ozminkowski
authors.forename: B
authors.initials: B
authors.lastname: Experton
authors.forename: Z
authors.initials: Z
authors.lastname: Li
mesh_terms: D000368:Aged; D002140:California; D003363:Cost Control; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States