Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis

Abstract

Background: Medicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI) assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries.

Chronic wound care utilization among Veterans using VHA and Medicare

“…It is not clear from our study why Veterans used multiple systems for wound care and therefore it is difficult to know whether Veterans with poorly healing wounds seek other sources of care or if characteristics of Veterans who use multiple systems also are associated with poorer wound outcomes. Although others have noted that dual users generally have more chronic and other health conditions than single-system users [9,11,13,23], in this study VHA-exclusive users had a similarly high comorbidity burden. Therefore, our finding of higher utilization among dual users is probably not explained by confounding by health status.…”

“…However, not all Veterans had an inpatient stay; therefore, we used a zero-inflated negative binomial model with robust standard errors to assess whether dual use was associated with inpatient stays. We adjusted both models for variables shown to be associated with dual use and utilization in other studies, namely age (and age squared), number of chronic conditions [9,11,13], rural residence [18,19], original reason for Medicare eligibility [20], wound etiology and baseline severity [21,22], distance to the nearest VHA facility and supply of non-VHA providers the Veteran's zip code [9,13,23]. In a second set of models, we included wound duration as a covariate.…”

“…In general, patients who use multiple health care systems have higher health care utilizationparticularly for outpatient visits -than single system users [11,12]. This higher utilization is due in part to the higher burden of comorbidity and disability among people who are eligible for multiple systems of care [9,11,13].…”

“…This higher utilization is due in part to the higher burden of comorbidity and disability among people who are eligible for multiple systems of care [9,11,13]. For example, when Moon et al adjusted for demographic and health characteristics, dual use of Medicare and Medicaid was no longer associated with higher utilization [11].…”

Implementing the Medicare drug benefit in a diverse inner-city community

“…3,12,13 Dual-eligible patients cost Medicare about 1.5 times as much as non-dual-eligible patients, and they CASE STUDY Medicare drug benefit are reported to be poorer and sicker, with higher prescription use than those with single coverage. [14][15][16] This article describes an integrated effort, including education, outreach, and operations management, to maintain continued access to pharmacy services and prescribed medications for patients in an inner-city community, particularly those dually eligible for Medicaid and Medicare, before and during the implementation of the Medicare prescription drug benefit.…”