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APHA Scientific Session and Event Listing

Bruce Friedman, PhD, MPH, 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, Brenda R. Wamsley, PhD, Department of Social Work, West Virginia State University, 928 Wallace Hall, P.O. Box 1000, Institute, WV 25112, Hongdao Meng, PhD, Department of Preventive Medicine, Stony Brook University, HSC, Level 3, Rm 071, Stony Brook, NY 11794-8338, and Gerald Eggert, PhD, Rural Health Consultant, 28 Lawton Street, Rochester, NY 14607.

Previous logged linear regression analyses of the Medicare Primary and Consumer-Directed Care Demonstration compared mean Medicare, non-Medicare, and total healthcare expenditures of the 451 rural (non-Metropolitan Statistical Area) participants who were cognitively intact (Cognitive Performance Scale [CPS] score < 2) versus those who were cognitively impaired (CPS>1). We found that none of the 3 interventions (Nurse, Voucher, and their combination) appear to have had an impact on mean total healthcare expenditures among cognitively intact rural patients (n=334). However, for the cognitively impaired it is likely that the interventions had considerable effects on Medicare, non-Medicare, and total healthcare expenditures although our regression models did not detect statistical significance at conventional levels because of the small sample size (n=115). Specifically, the coefficient for the Nurse group was negative and fairly large for total healthcare expenditures (-.45; t=-1.28) and for Medicare expenditures (-.64; t=-1.46). The coefficient for the Voucher group was negative and fairly large for Medicare expenditures (-.44; t=-1.10), and was positive and fairly large for non-Medicare expenditures (.42; t=1.05). Here we will present the results for 3 logged linear regression models, one each for mean Medicare, non-Medicare, and total healthcare expenditures, utilizing the entire study population (N=1605) to increase the statistical power of our analyses. We will generate standardized predictions for rural cognitively impaired, rural cognitively intact, urban cognitively impaired, and urban cognitively intact patients, and will then determine statistical significance using bootstrapped confidence intervals. Policy implications will be discussed.

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 from those of the urban patients both for the cognitively intact and the cognitively impaired.
• The participants in the session will be able to identify and describe how healthcare expenditures differed across the several interventions in the Demonstration for rural as compared to urban patients among both the cognitively intact and the cognitively impaired.

Keywords: Medicare, Consumer Direction

Presenting author's disclosure statement:

Any relevant financial relationships? No