title: Effect of long-term care use on Medicare and Medicaid expenditures for dual eligible and non-dual eligible elderly beneficiaries.
abstract: BACKGROUND
  Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs.
  
  
  OBJECTIVE
  To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use.
  
  
  METHODS
  Secondary analysis of linked MAX and Medicare data in seven states.
  
  
  METHODS
  Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles.
  
  
  METHODS
  Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures.
  
  
  RESULTS
  Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs.
  
  
  CONCLUSIONS
  Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures.
authors.affiliation: University of Minnesota School of Public Health.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.affiliation: University of Minnesota School of Public Health.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wysocki
authors.affiliation: University of Minnesota School of Public Health.
authors.forename: Shriram
authors.initials: S
authors.lastname: Parashuram
authors.affiliation: University of Minnesota School of Public Health.
authors.forename: Tetyana
authors.initials: T
authors.lastname: Shippee
authors.affiliation: The University of Hong Kong.
authors.forename: Terry
authors.initials: T
authors.lastname: Lum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004608:Eligibility Determination; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Access; Aging; Chronic Disease; Demand; Disability; Elderly; Geriatrics; Health Care Costs; Home Care; Long Term Care; Medicaid; Medicare; Nursing Homes; Utilization of Services
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