Poster Paper: Emergency Department Use Among Working Age and Older Adults Dually Eligible for Medicare and Medicaid

Saturday, November 9, 2013
West End Ballroom A (Washington Marriott)

*Names in bold indicate Presenter

Shreyasi Deb, MBA, Adele M. Kirk and Nancy A. Miller, University of Maryland
Objective: This poster examines the difference in utilization of emergency department use between older (> 65 years) and younger (< 65 years) populations who are dually eligible for both Medicare and Medicaid (henceforth referred to as “duals”).

Background: It is well-documented in the literature that duals are a heterogeneous population with diverse needs and health care costs. The over-65 duals, are more likely to be in poorer health and more expensive to treat than the general Medicare population. The under-65 duals usually have some kind of disability but are likely to incur lower per-capita spending than the elderly duals. Due to the eligibility criteria, both of these groups have low incomes (mostly less than 150 percent of the Federal Poverty Level). Emergency visits are an important expense for both of these age-groups. Our study contributes to the existing knowledge base by comparing the under-65 with over-65 duals and teasing out their emergency hospital utilization.

Methods: Data has been derived from the Household Component of the Medical Expenditure Panel Survey (MEPS) 2001 – 2007.  Adapting Andersen’s Behavioral Model of Health Care Access, we use multivariate logistic regression to model measures of use (emergency department use) as a function of predisposing, enabling, need and contextual factors. Our main regressors are race/ethnicity, education, gender, income, marital status, geographical location, self-reported health status and disability status (as operationalized by Altman disability measures).

Results: We found there is disparity in emergency department use and unmet medical needs between these two age groups. While having a usual source of care (place or person) does not affect emergency department use by older adults in our sample, there is a significant reduction in such utilization for the younger sample. There is no significant difference between men and women among the older population in emergency department use but women are more likely to use emergency care as compared to men among the younger duals.

Conclusion: The Centers for Medicare and Medicaid Services (CMS) have instituted many demonstration projects to improve the coordination of care for the duals mainly through capitated models and managed fee-for-service models. However, these programs club the duals together in a single group. It is important for policy makers to differentiate between the elderly and non-elderly duals based on their differential needs. We propose that this would improve the quality of care and reduce costs of services provided.