Abstract
State-level variations in disease, healthcare utilization, and spending influence healthcare planning at federal and state levels and should be examined to understand national disparities in health outcomes. This descriptive study examined state-level variations in Parkinson disease (PD) prevalence, patient characteristics, Medicare spending, out-of-pocket costs, and health service utilization using data on 27.5 million Medicare beneficiaries in the US in 2014. We found that 45.8% (n = 179,496) of Medicare beneficiaries diagnosed with PD were women; 26.1% (n = 102,205) were aged 85+. The District of Columbia, New York, Illinois, Connecticut, and Florida had the highest age-, race-, and sex-adjusted prevalence of Parkinson disease among Medicare beneficiaries in the US. Women comprised over 48.5% of PD patient populations in West Virginia, Kentucky, Mississippi, Louisiana, and Arkansas. More than 31% of the PD populations in Connecticut, Pennsylvania, Hawaii, and Rhode Island were aged 85+. PD patients who were “dual-eligible”—receiving both Medicare and Medicaid benefits—also varied by state, from <10% to >25%. Hospitalizations varied from 304 to 653 stays per 1000 PD patients and accounted for 26.5% of the 7.9 billion United States Dollars (USD) paid by the Medicare program for healthcare services delivered to our sample. A diagnosis of PD was associated with greater healthcare use and spending. This study provides initial evidence of substantial geographic variation in PD patient characteristics, health service use, and spending. Further study is necessary to inform the development of state- and federal-level health policies that are cost-efficient and support desired outcomes for PD patients.
Highlights
State-level variation in disease prevalence,[1,2] health care utilization, spending/costs,[3,4] healthcare quality,[5] and clinical outcomes[6,7,8,9,10] have been observed among Medicare beneficiaries
We examined state-level variations in Parkinson disease (PD) patient characteristics, Medicare spending, out-of-pocket health care costs, and health service utilization
Variation in PD prevalence and characteristics We identified 27,538,023 Medicare beneficiaries that met our inclusion criteria, of whom 392,214 had a PD diagnosis in 2014
Summary
State-level variation in disease prevalence,[1,2] health care utilization, spending/costs,[3,4] healthcare quality,[5] and clinical outcomes[6,7,8,9,10] have been observed among Medicare beneficiaries. With the increasing prevalence of PD in the US, health care needs and costs will increase, so population-level data is needed to inform health policy and planning at the state and federal level to address these changing needs To address these gaps in knowledge, this descriptive study examined state-level variation in PD prevalence among US Medicare beneficiaries. We examined state-level variations in PD patient characteristics, Medicare spending, out-of-pocket health care costs, and health service utilization
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