title: Comparing the medical expenses of adults with Medicaid and commercial insurance in a health maintenance organization.
abstract: The objective of this study was to compare the health care costs of adults with Medicaid aged 19 to 65 years (n = 29,680) and adults in the same age range with commercial insurance (n = 29,680) who were members of the same health maintenance organization between 1996 and 1998. After adjusting for age and sex, income-eligible Medicaid-insured adults were $35 (29 percent) per month more expensive than commercially insured adults. The medically needy/indigent (excluding "spend-down") were $61 (51 percent) per month more expensive than commercially insured adults, and the blind or disabled were $289 (240 percent) per month more expensive. When the analysis adjusted for health status as well as age and sex, however, income-eligible Medicaid adults were $12 (p = 0.01) per month less costly than commercially insured adults. The costs of Medicaid-insured adults were substantially higher than those of commercially insured adults; these differences were likely due to higher rates of pregnancy and to worse health status among the Medicaid cohort.
authors.affiliation: Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, California, USA.
authors.forename: G Thomas
authors.initials: GT
authors.lastname: Ray
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000328:Adult; D002140:California; D006233:Persons with Disabilities; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics*; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D017149:Private Sector; D017664:Uncompensated Care / Q000191:economics; D014481:United States