Abstract 5922: Sex and Race Dictate Health Care Resource Utilization by Medicare Beneficiaries with Mild to Severe Heart Failure
Little is known regarding the impact of sex or race on health care spending in Medicare beneficiaries with heart failure (HF). Published data have focused on hospitalizations and quality of care in this population, but have not addressed costs nor HF severity. An analysis of 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. Three cohorts were defined according to mild, moderate, severe HF severity employing the Centers for Medicare & Medicaid Services Hierarchical Condition Categories Model & Chronic Care Improvement Program definitions. Each cohort was stratified by sex and race (black & white). Based on inclusion criteria, 1,707,760 beneficiaries were identified. The table⇓ below summaries total payments per capita spent on total care for 2005. We evaluated the percentage of total costs by acute (emergency department & inpatient hospitalizations) and chronic care (outpatient physician visits). As disease severity increased, the percentage of total spending for acute care services increased from 58% to 66%. For male beneficiaries with mild, moderate, or severe HF, 68% of total health care spending was for acute services compared to 60% for women. In black beneficiaries with mild or moderate HF, 67% of total health care spending was for coverage of acute care services compared to 56% for white beneficiaries. In black beneficiaries with severe HF, 69% of total spending went to coverage for acute care services compared to 63% for white beneficiaries. Spending for health care resources, especially for acute care, was higher for blacks vs whites and males vs females in each HF severity category. As severity of HF increased, so did spending for acute care services. Understanding of the reasons for these cost differences, particularly for acute care, may reduce spending and improve care for beneficiaries with HF.