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Home healthcare spending by seniors, 1996-2000: Dual eligibles and Medicare only beneficiaries

Sangho Moon, PhD, Graduate School of Governance, Sungkyunkwan University, 53, 3-Ga, Myongryun-Dong, Chongno-Gu, Seoul, 110-745, South Korea, (82-2) 760-0367, smoon@skku.edu and Jaeun Shin, PhD, Department of Economics, Texas A&M University, 3035 Allen Building, 4228 TAMU, College Station, TX 77843-4228.

The Medicare-Medicaid dually eligibles represent only one-fifth of each program's enrollment, but account for a much larger share (24% in Medicare, 35% in Medicaid) of each program's total expenditures. They are disadvantaged in demographic, economic and health conditions including self-perceived health status and the number of comorbidities. This study estimates trends and utilization patterns of home health services among dual eligibles as apposed to Medicare only beneficiaries. We employ different parametric estimation models in order to deal with possible distributional misspecification due to overdispersion and excess zeros in count data. Based on various specification tests, zero-inflated negative binomial (ZINB) model is found to be the best fit in estimating the effect of dual eligibility. The semiparametric estimation of the additive partial linear model is used to relax parametric functional assumptions. Using the household component of Medical Expenditure Panel Survey 1996-2000, we find that dual eligibles are more likely to spend on agency-sponsored home healthcare services in the recent years of 1996-2000. Annual spending on agency-sponsored services, $2602.21, is much higher among dual eligibles than among Medicare only beneficiaries, $387.58. But the estimated expenditures of dual eligibles on the independently paid providers' home healthcare services ($56.14) is not statistically different from $42.09 of the Medicare only recipients. Medicare only beneficiaries do not have sufficient coverage for home health care. The Medicaid coverage of home health services toward dual eligibles is responsible for their frequent use of agency-sponsored care and hence high spending on total home health services.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

Keywords: Home Care, Elderly

Related Web page: www.meps.ahrq.gov/

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey 1996-2000
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.

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The 132nd Annual Meeting (November 6-10, 2004) of APHA