House calls to the elderly--a vanishing practice among physicians

Area of Science:

• Geriatrics
• Health Services Research
• Public Health

Background:

• Physician home visits have significantly declined despite increased home health care services.
• This study examines the frequency and characteristics of physician house calls to elderly U.S. patients in 1993.

Purpose of the Study:

• To determine the frequency of physician house calls made to elderly Medicare beneficiaries in 1993.
• To analyze the patient and physician characteristics associated with these house calls.

Main Methods:

• Analysis of a 5% random sample of 1993 Medicare Part B claims data for beneficiaries over 65 not in health maintenance organizations (HMOs).
• Utilized supplemental data from the Area Resource File and American Medical Association's Physician Masterfile.
• Examined house call frequency, cost, and characteristics of physicians and patients.

Main Results:

• In 1993, an estimated 727,000 house calls were made to 238,340 elderly Medicare patients, costing $63 million.
• Patients receiving house calls were older, more likely to die within the year, had higher hospitalization rates, and used other home health services.
• House calls were more common in rural areas, areas with high physician-to-population ratios, and for patients receiving other home health services.
• Physicians making house calls were more likely to be generalists, osteopaths, older, male, board-certified, in solo practice, and located in the Northeast.

Conclusions:

• Only 0.88% of eligible elderly Medicare patients received physician house calls in 1993.
• These house calls predominantly served very sick patients, often near the end of life.
• The findings highlight the specialized role of physician home visits for the most vulnerable elderly population.