Profiling resource use by primary-care practices: managed Medicare implications

• Published in: Health care financing review Vol. 17; no. 4; pp. 23 - 42
• Main Authors: Parente, S T, Weiner, J P, Garnick, D W, Fowles, J, Lawthers, A G, Palmer, R H
• Format: Journal Article
• Language: English
• Published: United States Superintendent of Documents 1996; CENTERS for MEDICARE & MEDICAID SERVICES
• Subjects: Aged; Alabama; Ambulatory care; Beneficiaries; Fee-for-Service Plans; Health care; Health care delivery; Health care expenditures; Health maintenance organizations; Health services; Health Services Research - methods; HMOs; Humans; Hypotheses; Institutionalization; Insurance Claim Review; Iowa; Least-Squares Analysis; Managed care; Managed Care Programs - statistics & numerical data; Maryland; Medicaid; Medicare; Medicare Part A - statistics & numerical data; Medicare Part B - statistics & numerical data; Multivariate Analysis; Physicians; Primary care; Primary Health Care - economics; Primary Health Care - statistics & numerical data; Referral and Consultation - statistics & numerical data; Rural areas; Service Delivery in an Evolving Managed Care Environment; Studies; United States; Utilization Review - methods; United States > US
• ISSN: 0195-8631; 1554-9887

Variations in elderly Medicare beneficiaries' health service use are examined using a 100-percent sample of fee-for-service (FFS) claims data from Alabama, Iowa, and Maryland. Provider specialty, group practice type, practice size, and location are found to be significant factors affecting hospital and ambulatory care utilization and cost, after controlling for patient and regional characteristics. These results provide insights into utilization and cost expectations from different types of primary-care gatekeepers as the Medicare managed care market develops.