Use of ambulatory care resources by Medicare-age patients in a primary care group practice

The increase in the number of persons age 65 and over-the Medicare-age group-and the increasing cost of providing medical care to patients in this group have focused attention on enrollment of these persons in capitated plans as a means of containing costs. Although much is known about resources used for inpatient care for Medicare-age patients, detailed information organized on a per-patient, per-year basis about ambulatory care of these patients is lacking. In order to address this problem and to investigate possible differences in resource use by age groups within the Medicare-age population, a study was made of a primary care group practice in which 523 patients, including 174 patients in the Medicare-age group, were followed for one year to determine their use of ambulatory care resources. A comparison of annual resource use by patients age 75 and over with patients age 65 through 74 showed that patients age 75 and over made more visits for primary care (8.15 vs. 6.46), made more visits to specialty and subspecialty clinics (3.41 vs. 2.33) and had higher total charges for ambulatory care ($749 vs. $623). The pattern of use of specialty and subspecialty clinics suggests that the primary care physicians functioned effectively as gatekeepers because most medical problems were handled without referrals to medical subspecialty clinics. The pattern also suggests that the projected rapid increase between now and the year 2000 in the number of persons age 75 and over may result in a greater than anticipated demand for services provided by ophthalmologists, podiatrists, and otolaryngologists.