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Consistently high users of medical care among the elderly
D K Freeborn1, C R Pope, J P Mullooly
1Center for Health Research, Kaiser Permanente, Northwest Region, Portland, OR 97215.
Insights
Consistently high medical care users, comprising 26% of older adults in a health maintenance organization (HMO), drove over half of all outpatient visits and hospital admissions, highlighting significant healthcare utilization disparities.
Area of Science:
- Gerontology
- Health Services Research
- Medical Economics
Background:
- Identifying patterns of healthcare utilization is crucial for resource allocation in aging populations.
- Understanding factors associated with high medical care use can inform targeted interventions.
Purpose of the Study:
- To identify consistently high and low users of medical care services among continuously enrolled older health maintenance organization (HMO) members over six years.
- To characterize the sociodemographic, clinical, and self-reported health differences between high and low healthcare users.
Main Methods:
- Analysis of six-year enrollment and claims data for older HMO members.
- Comparison of sociodemographic characteristics, medical conditions, self-rated health, and psychological distress between user groups.
Main Results:
- Consistently high users (26% of sample) accounted for over 50% of outpatient contacts and hospital admissions.
- High users incurred over four times greater ambulatory care costs than low users.
- High users were older, reported more chronic conditions (e.g., arthritis, hypertension, heart disease), perceived poorer health, and experienced higher psychological distress.
Conclusions:
- A distinct group of older adults drives a disproportionate amount of healthcare utilization and costs within an HMO setting.
- Chronic conditions, perceived health status, and psychological distress are key correlates of high medical care use in older populations.
- Findings suggest potential for proactive health management and resource optimization by identifying and supporting high-need individuals.
Abstract:
This study identified consistently high and low users of medical care services in a group of older HMO members continuously enrolled for six years. Consistently high users made up 26% of the sample, but accounted for more than 50% of total outpatient contacts and hospital admissions. Average ambulatory care costs were more than four times greater for the high users compared with the low users. Consistently high users were older than consistently low users, but did not differ significantly in other sociodemographic characteristics. Compared with the low users, the high users reported more total medical conditions and were more likely to indicate they had arthritis, high blood pressure, heart conditions, and other chronic problems. They perceived themselves to be in poorer health and reported higher levels of psychologic distress. The low users tended to be less satisfied, but the two user groups were not significantly different regarding use of services outside the HMO.