Geographic variation in out-of-pocket expenditures of elderly Medicare beneficiaries.
OBJECTIVE
To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans.


METHODS
Retrospective cohort study.


METHODS
Data from the Health and Retirement Study linked to Medicare claims.


METHODS
A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008.


METHODS
The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums.


RESULTS
Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001).


CONCLUSIONS
Medicare payments vary widely between high- and low-cost regions, but OOPEs do not.
Division of General Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Lena M
LM
Chen
Edward C
EC
Norton
Kenneth M
KM
Langa
Sidney
S
Le
Arnold M
AM
Epstein
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005843:Geography; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008297:Male; D006278:Medicare; D012189:Retrospective Studies; D014481:United States
Medicare; geographic variation; out-of-pocket expenditures