title: High-cost users among dual eligibles in three care settings.
abstract: This study compares the expenditure patterns and characteristics of high-cost dual eligibles to normative-cost dual eligibles within institutional and community settings. Using claims records for people dually eligible for both Medicare and Medicaid in 18 California counties (n=349,433) in 2000, high-cost users in the long-stay institutional care setting spent a much higher amount and a much greater proportion of total costs in Medi-Cal (61%) but spent less proportionally in Medicare (39%) than high-cost users in the long-term community care (66% of total costs from Medicare) or episodic care (79% of total costs from Medicare) setting. Although individuals who are long-stay nursing facility residents are high-cost in the overall sample, multinomial logistic regressions revealed that the impact of diseases/conditions on high-cost status varied within each setting. These findings suggest that policymakers and providers should consider care setting as an important component when designing disease management strategies.
authors.affiliation: CARF International in Tucson, Arizona, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Yip
authors.forename: Christy M
authors.initials: CM
authors.lastname: Nishita
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Crimmins
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Wilber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003153:Community Health Services / Q000191:economics* / Q000706:statistics & numerical data; D004608:Eligibility Determination; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D016015:Logistic Models; D008134:Long-Term Care / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States