title: Cost-sharing, physician utilization, and adverse selection among Medicare beneficiaries with chronic health conditions.
abstract: Pooled data from the 2007, 2009, and 2011/2012 California Health Interview Surveys were used to compare the number of self-reported annual physician visits among 36,808 Medicare beneficiaries ≥65 in insurance groups with differential cost-sharing. Adjusted for adverse selection and a set of health covariates, Medicare fee-for-service (FFS) only beneficiaries had similar physician utilization compared with HMO enrollees but fewer visits compared with those with supplemental (1.04, p = .001) and Medicaid (1.55, p = .003) coverage. FFS only beneficiaries in very good or excellent health had fewer visits compared with those of similar health status with supplemental (1.30, p = .001) or Medicaid coverage (2.15, p = .002). For subpopulations with several chronic conditions, FFS only beneficiaries also had fewer visits compared with beneficiaries with supplemental or Medicaid coverage. Observed differences in utilization may reflect efficient and necessary physician utilization among those with chronic health needs.
authors.affiliation: UCLA Fielding School of Public Health, Los Angeles, CA, USA gjhoff@gmail.com.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Hoffman
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D017047:Cost Sharing / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D016345:Medicare Part B / Q000191:economics / Q000706:statistics & numerical data; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: Medicaid/Medicare; access to and utilization of services; economics; health care policy; health insurance