Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #110493

Bruce Friedman, PhD, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 273-2618, Bruce_Friedman@urmc.rochester.edu, Hongdao Meng, PhD, Department of Preventive Medicine, Stony Brook University, HSC, Level 3, Rm071, Stony Brook University, Stony Brook, NY 11794-8338, Brenda R. Wamsley, PhD, Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, and Gerald Eggert, PhD, Executive Director, Monroe County Long Term Care Program, Inc, P.O. Box 429, East Rochester, NY 14445.

The Medicare Primary and Consumer-Directed Care Demonstration was a randomized controlled trial that tested the effectiveness of two models of consumer-directed care, a Voucher and a chronic disease self-management/health promotion Nurse intervention, plus their Combination, among Medicare beneficiaries who were functionally disabled and at increased risk for high healthcare costs.

Methods: Here we compare mean Medicare, non-Medicare, and total healthcare expenditures of two groups of the 449 rural (non-Metropolitan Statistical Area) participants: those who the Mini-International Neuropsychiatric Interview [MINI] Major Depressive Episode module identified as having major depression at baseline (n=70) and those without major depression (n=379).

Results: Including intervention costs, mean monthly total healthcare expenditures for the non-depressed participants were extremely similar for the Control, Voucher, and Nurse groups ($1545, $1562, and $1577 per patient per month, respectively) but were higher for the Combination group ($1645). For the patients with major depression expenditures were considerably lower for the Voucher and Combination groups ($1655 and $1499, respectively) than for the Control and Nurse groups ($2393 and $2265, respectively). Non-Medicare expenditures were 52%, 28%, and 18% lower for the Voucher, Nurse, and Combination groups, respectively, than for the Control group. Similarly, Medicare expenditures were 50% and 17% lower, respectively, for the Combination and Voucher groups than for the Control group. However, they were 10% higher for the Nurse group.

Conclusion: While none of the 3 interventions reduced mean total healthcare expenditures for non-depressed rural patients, the Voucher and Combination interventions reduced both Medicare and non-Medicare expenditures for depressed rural patients.

Learning Objectives:

• The participants in the session will acquire information about how healthcare expenditures of rural patients in the Medicare Primary and Consumer-Directed Care Demonstration differed between patients with and without major depression at baseline.
• The participants in the session will be able to identify and describe how healthcare expenditures differed across the several interventions in the Demonstration for patients with and without major depression at baseline.

Keywords: Medicare, Rural Health Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.