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      Resident Medical Care Utilization Patterns in Continuing Care Retirement Communities

      research-article
      , Ph.D., , M.A., , Ph.D.
      Health Care Financing Review
      CENTERS for MEDICARE & MEDICAID SERVICES

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          Abstract

          This article presents the findings of an evaluation of medical care service utilization by two elderly cohorts one living in continuing care retirement communities (CCRCs) and the other living in traditional community settings. CCRC residents' overall use of Medicare-covered medical services did not differ significantly from that of the traditional community-residing elders. Both groups incurred annual per capita expenditures of approximately $2,000. In their last year of life, however, CCRC residents displayed significantly lower expenditures for hospital care ($3,854 versus $7,268) but higher expenditures for Medicare or non-Medicare-covered nursing home care ($5,565 versus $3,533).

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          Most cited references33

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          An analysis of the use of Medicare services by the continuously enrolled aged.

          This article discusses the utilization patterns of the Medicare aged who were continuously enrolled in the program for over a 4-year period. Data used for this study were compiled from a random sample of Medicare beneficiaries in Colorado who were continuously enrolled from October 1974 through December 1978. Five utilization variables: medical office visits, medical relative value units (RVUs), surgical RVUs, inpatient days, and covered dollars were examined in the article. Results from this study are consistent with previous longitudinal analyses. Consistent high users of services who consume substantial proportions of total expenditures and consistent nonusers having no or few services were found. During an average year of the 4-year period, it was observed that 18 per cent of the beneficiaries accounted for 88 per cent of the cost of services delivered. Because these high users tend to remain high users over time--more than one third of the high users in a given year continue to be high users during the following year--the findings here suggest that cost-containment strategies targeted to these high users may have a strong impact on overall Medicare program costs. Multivariate analysis is also conducted in this article so that the determinants of utilization patterns over time could be examined. Of particular interest is the finding that seasonal and trend variables play an important role in determining utilization over time.
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            Patterns of expenditures among high utilizers of medical care services. The experience of Medicare beneficiaries from 1974 to 1977.

            The authors of this study examine temporal patterns of medical expenditures by Medicare beneficiaries. A random sample of 204,917 individuals who were alive and in the program from 1974 to 1977 was investigated. Individuals hospitalized in 1974 were found to have twice the rate of hospitalization in 1975, 1976, or 1977 compared with individuals who were not hospitalized in 1974. The increased rate of hospitalization remained constant throughout the 3 years. Individuals with large medical expenditures in 1974 were 20 times more likely to have large medical expenditures the following year, and this rate declined slowly in the following 2 years. The results suggest that the value of a Medicare voucher or the level of Medicare's payment to health maintenance organizations should include an adjustment factor for prior health care utilization. The results also suggest that multiyear limits on total Medicare coinsurance and deductible payments would be more equitable than single-year limits.
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              The risk factors of nursing home entry among residents of six continuing care retirement communities.

              We identified client characteristics related to nursing home entry for 3,316 residents of six continuing care retirement communities with a longitudinal dataset that follows an initially healthy entry cohort for up to 15 years. The Cox Proportional Hazards Model was used for the analysis of survival data that includes censored data. We calculated hazard indices for residents with different characteristics to show the independent effect of these variables on the probability of nursing home entry. Seven variables emerged as statistically significant covariates: sex, marital status, roommate status, entry year into the community, entry age into the community, number of hospitalizations, and community of residence. The community of residence, which in large part reflects system effects on nursing home entry, was found to be the single most important variable explaining variance in the data. Tobit analysis was used to examine the factors associated with multiple nursing home entries and total days per year spent in a nursing home. With a few exceptions, most of the variables listed above were also significant correlates of multiple entries and total days per year spent in a nursing home.
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                Author and article information

                Journal
                Health Care Financ Rev
                Health Care Financ Rev
                HCFR
                Health Care Financing Review
                CENTERS for MEDICARE & MEDICAID SERVICES
                0195-8631
                1554-9887
                Summer 1993
                : 14
                : 4
                : 151-168
                Article
                hcfr-14-4-151
                4193352
                10133107
                a0e58c5e-3f59-4a41-80b0-c774d586905e
                Copyright @ 1993
                History
                Categories
                Long-Term Care: Emerging Trends

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