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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Christine E. Bishop, PhD1, Daniel Gilden, MS2, Jacobus Blom, PhD1, Joanna Kubisiak, MPH2, Rosemarie B. Hakim, PhD3, Angelina Lee, PhD2, and Deborah W Garnick, ScD1. (1) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA 02454, (2) JEN Associates Inc., 5 Bigelow Street, Cambridge, MA 02139, (3) Office of Strategic Planning, Research & Evaluation Group, Div. of Beneficiary Research, Centers for Medicare and Medicaid Services, 7500 Security Blvd., Mail Stop: C3-19-07, Baltimore, MD 21244-1850, 410-786-6698, bishop@brandeis.edu
Medicare expenditures for covered services related to injuries were estimated using 1999 claims for a 5-percent sample of Medicare fee-for-service (FFS) beneficiaries. We classified claims by injury diagnosis, using a modified Barell matrix. Enrollment files provided information on beneficiary age, sex, and HMO enrollment. Twenty percent of all FFS beneficiaries had claims for one or more injury diagnoses in 1999, for total Medicare expenditures of over $8 billion. Females were more likely to incur injury claims than males in every age class. Medicare expenditure per beneficiary experiencing any injury claim was $1432. Fractures were the most common injury, experienced by over 5% of FFS beneficiaries; their $5.5 billion expense was 68% of Medicare injury expenditures. Fractures of the lower extremities (ICD-9 820 - 827) were especially expensive for Medicare. Contusions and sprains were also common, but resulted in lower expenditures per injured beneficiary and lower total expenditures. Injuries, especially fractures, are an important cause of Medicare expenditures for persons 65 and older, and perhaps could be reduced through prevention activities. Estimated total Medicare expenditures for injury claims represent an upper bound for potential Medicare savings from prevention. Medicare savings would be substantial if even half of expenditures due to injury could be avoided or mitigated through preventive measures. We conclude that estimates from claims of the number and characteristics of beneficiaries experiencing injuries and the cost to the Medicare program of injuries by type could support Medicare injury prevention initiatives for the elderly.
Learning Objectives:
Keywords: Injury, Medicare
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.