Effect of 3 interventions on healthcare costs of rural and urban Medicare beneficiaries with and without major depression

The Medicare Primary and Consumer-Directed Care Demonstration (N=1605) was a randomized controlled trial that examined the acceptability and effectiveness of 3 interventions on health status, function, and healthcare costs. We used linear regression analyses to compare the effects of the Nurse, Voucher, and Combination (Nurse plus Voucher) interventions on Medicare, Non-Medicare, and total healthcare expenditures for 4 groups of participants in the Medicare Primary and Consumer-Directed Care Demonstration: rural depressed (n=70), rural non-depressed (n=379), urban depressed (n=212), and urban non-depressed (n=934). These analyses controlled for site, age, Medicare supplemental (Medigap) insurance, Cognitive Performance Scale score, SF-36 Physical Component Summary score, number of dependencies in activities of daily living, number of dependencies in instrumental activities of daily living, and number of study days. For the rural depressed, the Combination intervention was associated with significantly lower total healthcare expenditures (p=.032) and lower Medicare expenditures (p=.070) for both sites combined, and for higher Non-Medicare expenditures at the New York site (p=.004). For the rural depressed the Nurse intervention was associated with higher Non-Medicare expenditures at both the New York (p=.003) and the West Virginia/Ohio (p=.059) sites. The Voucher intervention was also associated with higher Non-Medicare expenditures at the New York site (p=.096). For the rural non-depressed, Non-Medicare expenditures were significantly higher for the Voucher and Combination interventions (p=.038 and p=.058, respectively). For the urban depressed and the urban non-depressed, there were no statistically significant effects for any of the three interventions on Medicare, Non-Medicare, and total healthcare expenditures. Policy implications will be discussed.