Geographic Variation in Out-of-Pocket Expenditures of Elderly Medicare Beneficiaries.

Journal of the American Geriatrics Society

PubMedID: 24852182

Chen LM, Norton EC, Langa KM, Le S, Epstein AM. Geographic Variation in Out-of-Pocket Expenditures of Elderly Medicare Beneficiaries. J Am Geriatr Soc. 2014;62(6):1097-104.
OBJECTIVES
To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans.

DESIGN
Retrospective cohort study.

SETTING
Data from the Health and Retirement Study linked to Medicare claims.

PARTICIPANTS
A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008.

MEASUREMENTS
The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums.

RESULTS
Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001).

CONCLUSION
Medicare payments vary widely between high- and low-cost regions, but OOPEs do not.