Use and costs of ambulatory care services among medicare enrollees with schizophrenia

Objective: The objective of this study was to identify predictors of the use and cost of ambulatory care services among Medicare recipients with schizophrenia. Methods: The design was a cross-sectional analysis of Medicare claims in 1991. The study subjects were a 5 percent random sample of all persons in the United States who had at least one Medicare service claim in 1991 and who were diagnosed as having schizophrenia in any care setting. Outcome measures included use and cost of any ambulatory care service, individual therapy, psychiatric somatotherapy, group therapy, or family therapy. Results: For nearly 25 percent of the total sample of 12,440, no claims were filed for ambulatory care services in 1991. The mean±SD number of ambulatory care visits during the year was 7.9±21. The most frequently used type of therapy was individual therapy (5±14 visits). The mean±SD yearly cost of care for persons who received ambulatory care services was $470±$1,028. Among persons under 65 years of age, Caucasians were about 1.5 times as likely as African Americans to have received an ambulatory care service and 1.3 times as likely to have received individual therapy. Persons who were 65 or older were less likely to have received any service. Among service recipients, costs of care were lower for African Americans and for older people. Conclusions: The use of Medicare-funded ambulatory care services by persons with schizophrenia varied by race and age. Further investigation is required to determine whether subgroups of individuals who do not have additional insurance coverage or access to services are receiving substandard care.