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Health Serv Res. 2016 Apr;51(2):625-44. doi: 10.1111/1475-6773.12339. Epub 2015 Jul 26.

Comparing the Cost of Caring for Medicare Beneficiaries in Federally Funded Health Centers to Other Care Settings.

Author information

1
Department of Medicine, University of California, Irvine, Irvine, CA.
2
Biological Sciences Division, Medicine, General Internal Medicine, University of Chicago, Chicago, IL.
3
Department of Health and Human Services, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, MD.
4
Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
5
Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MD.

Abstract

OBJECTIVE:

To compare total annual costs for Medicare beneficiaries receiving primary care in federally funded health centers (HCs) to Medicare beneficiaries in physician offices and outpatient clinics.

DATA SOURCES/STUDY SETTINGS:

Part A and B fee-for-service Medicare claims from 14 geographically diverse states. The sample was restricted to beneficiaries residing within primary care service areas (PCSAs) with at least one HC.

STUDY DESIGN:

We modeled separately total annual costs, annual primary care costs, and annual nonprimary care costs as a function of patient characteristics and PCSA fixed effects.

DATA COLLECTION:

Data were obtained from the Centers for Medicare & Medicaid Services.

PRINCIPAL FINDINGS:

Total median annual costs (at $2,370) for HC Medicare patients were lower by 10 percent compared to patients in physician offices ($2,667) and by 30 percent compared to patients in outpatient clinics ($3,580). This was due to lower nonprimary care costs in HCs, despite higher primary care costs.

CONCLUSIONS:

HCs may offer lower total cost practice style to the Centers for Medicare & Medicaid Services, which administers Medicare. Future research should examine whether these lower costs reflect better management by HC practitioners or more limited access to specialty care by HC patients.

KEYWORDS:

Federally funded health centers; Medicare; costs; primary care; specialty care

PMID:
26213167
PMCID:
PMC4799905
DOI:
10.1111/1475-6773.12339
[Indexed for MEDLINE]
Free PMC Article

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