Age and gender differences in medicare expenditures and service utilization at the end of life for lung cancer decedents.

PURPOSE: Gender and age differences in medical care are well documented. We examined age and gender differences in Medicare expenditures for lung cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data. METHODS: Participants were aged Medicare beneficiaries (>or=68) with lung cancer, who were covered by Parts A and B for 36 months before death (1996-1999; n = 13,120). Regression techniques were used to estimate age and gender differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service, conditional on use: inpatient, outpatient, physician, skilled nursing facility (SNF), home health, and hospice, controlling for demographic, clinical, geographic, and supply characteristics. RESULTS: Women were more likely than men to use inpatient, SNF, home health, and hospice services. Women's average expenditures were approximately dollars 1,900 greater than men's, with differences attributed to higher average expenditures for SNF, home health, and hospice. Older cohorts used fewer inpatient and outpatient services and used more SNF and hospice services in their LYOL. Average Medicare expenditures were significantly lower in older cohorts (dollars 8,487 less for those age >or=85 at death than for those 68-74). Adjusting for age explains most of the gender differences in average Medicare expenditures. Remaining gender differences vary across age cohorts, with larger gender differences in social-supportive service expenditures among those 68-74 and 75-84 and outpatient and physician services among those 75-84 and >or=85. DISCUSSION AND CONCLUSIONS: Our findings suggest that gender disparities in expenditures are generally small at the end of life for lung cancer decedents, particularly among the older cohorts. As expected, the bigger observed differences are by age although the direction of the association is not consistent across types of service. Higher expenditures for women on social-supportive services may reflect fewer informal supports for older women compared with men.

Partially capitated managed care versus FFS for special needs children.

Little research has examined whether Medicaid managed care plans (MCPs) that incorporate case management are effective in coordinating services for children with special health care needs (CSHCN). This study evaluates the effects of enrollment of special needs children into a partially capitated MCP (with ongoing case management) versus the fee-for-service (FFS) option on use of therapeutic services, specifically speech, occupational, and physical therapy by site of service (school versus health care sector). Results show that special needs children enrolled in the partially capitated MCP are significantly more likely to obtain occupational and physical therapy at school relative to their FFS counterparts. Moreover, children enrolled in FFS are significantly less likely to be either regular or frequent users of each type of therapy relative to children enrolled in managed care. We attribute much of these disparities in use of therapeutic services at school to the availability of case management and coordination that is an integral component of the partially capitated MCP.

Age and gender differences in Medicare expenditures at the end of life for colorectal cancer decedents.

PURPOSE AND METHODS: We examined age and gender differences in Medicare expenditures for colorectal cancer decedents in the last year of life (LYOL) through a cross-sectional study of Medicare administrative and claims data. Participants were aged Medicare beneficiaries (68+ years) with colorectal cancer, who were covered by Parts A and B for 36 months before death (1996-1999, n = 6657). We estimated differences in mean Medicare utilization and expenditures in the LYOL overall and by type of service (inpatient, outpatient, physician, skilled nursing facility [SNF], home health, and hospice). RESULTS: Women were more likely than men to use inpatient services, SNF services, home health, and hospice in the LYOL. Average expenditures for women were $1600 higher than for men, which were attributed to higher average expenditures on home health and hospice services. Among decedents aged 68-74 who used inpatient care, inpatient expenditures were higher for women than men. Older cohorts were less likely to use inpatient and outpatient services and more likely to use SNF services. Average Medicare expenditures were significantly lower in older cohorts. CONCLUSIONS: Most of the gender differences in average Medicare expenditures were explained by gender differences in age and the lower average expenditures on older decedents with colorectal cancer. Remaining gender differences varied across age cohorts and were largest among those aged 68-74. Higher expenditures for women on each of the social supportive services (SNF, home health, and hospice), even among those who used a particular type of service, may reflect a lack of informal supports for older women compared with men.