Cost Of Health Care Services Research Articles

The impact of remission duration on the long-term economic burden of acute myeloid leukemia among patients without hematopoietic stem cell transplant in the United States

Background and aims Acute myeloid leukemia (AML) prognosis is poor, with sustained remission occurring in <35% of young adults and <15% of older adults. This descriptive study examined the potential benefit of prolonged remission on the economic burden of AML. Methods Using the IBM MarketScan Commercial and Medicare Supplemental databases, we identified newly diagnosed patients with AML without hematopoietic stem cell transplantation from January 1, 2012 to December 31, 2018; AML diagnosis was the index date. Patients had 6 months of pre-index eligibility and were followed until the end of continuous eligibility, study data, or death. Active treatment and supportive care cohorts were defined; duration-of-remission subgroups (0 to <3, 3 to <6, 6 to <12, and ≥12 months) were established among active treatment patients with remission. Healthcare service utilization and costs were reported over follow-up and mutually exclusive treatment, remission, and post-relapse periods. Results This study included 1,558 active treatment and 1,127 supportive care patients who were followed for a median of 232 and 62 days, respectively. Over follow-up, active treatment and supportive care patients incurred mean ± standard deviation all-cause healthcare costs of $55,723 ± $61,994 and $68,596 ± $100,375 per-patient-per-month (PPPM), respectively. Decreasing PPPM costs were observed with increased remission duration (0 to <3 months: $71,823 ± $62,635; 3 to <6 months: $54,262 ± $44,734; 6 to <12 months: $35,287 ± $23,699; and ≥12 months: $15,615 ± $10,560). Although median follow-up varied by up to 5-fold, total costs were largely similar across duration-of-remission subgroups (0 to <3 months: $438,569 ± $332,675; 3 to <6 months: $590,411 ± $598,245; 6 to <12 months: $482,902 ± $369,115; and ≥12 months: $448,867 ± $316,133). Conclusions The economic burden of AML is substantial, even among untreated patients. Further, among patients with remission, longer durations in remission are associated with reduced PPPM healthcare costs, suggesting that remission-prolonging treatments could help mitigate healthcare costs.

Beyond the Drinker: Alcohol's Hidden Costs in 2016 in Australia

Drawing on a study of the range and magnitude of harms that alcohol caused to specific others in Australia, and on social and health agency statistics for collective costs, this article produces an analysis of the economic cost of alcohol's harm to others (AHTO) in Australia. This study used a general population survey and routinely collected social response agencies' data to quantify different costs of AHTO, using methods consistent with International Guidelines for Estimating the Costs of Substance Abuse. This approach estimates costs for health care and social services, crime costs, costs of productivity loss, quality of life-year loss and other expenses, including both tangible costs (direct and indirect) and intangible costs of loss of quality of life (respondents' self-reported loss of health-related quality of life). The cost of AHTO in Australia was AUD$19.81 billion (95% CI [11.99, 28.34]), with tangible costs accounting for 58% of total costs ($11.45 billion, which is 0.68% of gross domestic product in 2016) and intangible costs of $8.36 billion. The costs to private individuals or households ($18.1 billion and 89% of total costs of AHTO) are greater than the costs to the government or society because of others' drinking in Australia. This study presents an estimation of the economic cost of harm from others' drinking. The economic costs from others' drinking are large and of much the same magnitude as the costs that drinkers impose on themselves, as found in previous studies. Preventing harm to others from drinking is important as a public health goal for both economic and humane reasons.

THU226 - Low health literacy is associated with higher healthcare service utilisation and costs among patients with cirrhosis

THU226 - Low health literacy is associated with higher healthcare service utilisation and costs among patients with cirrhosis

Productivity Analysis of Medical Record Department in Hospitals Affiliated with Urmia University of Medical Sciences

Background: The importance of paying attention to improving productivity in different health system departments has become increasingly evident. This is due to increased costs of health care goods and services, limited resources and production facilities. This study aims to measure the productivity of hospitals' Medical Records Departments (MRD) affiliated with Urmia University of Medical Sciences to provide a comprehensive analysis of their performance. Methods: In this study, total productivity and total factor productivity changes of medical record departments in hospitals affiliated with Urmia University of Medical Sciences were calculated. This was conducted through Kendrick-Creamer and Malmquist indexes in 2016-2020, and has examined the trend of each one of them. Input variables included the number of personnel and equipment. Output variables encompassed the number of outpatient and inpatient medical records prepared for patients, responses to letters, and patients referred to the studied MRD. After estimating the production function, the elasticity of production factors and the return to the scale of medical record departments were calculated.Total productivity changes and production function were estimated via Deap2,1 and Frontier4,1 softwares by applying input minimization and variable returns to scale assumptions. Results: The results of the Malmquist index indicated that the average total productivity changes of medical records departments of hospitals during the study period were equal to 1,096. This is greater than one; therefore, it can be concluded that productivity has decreased by about 9.600 % during the study period. Changes in technological efficiency have had the greatest impact on reducing productivity, to other factors. In addition, the results of Kendrick-Creamer index during the years under review demonstrated that the average total productivity of production factors obtained, was equal to 18725.530 services. Conclusion: There is decreased productivity due to technological changes in the studied departments. This is because of the lack of sufficient knowledge of the medical records department staff in the use of technology and equipment for providing efficient services . Holding training courses for the appropriate use of technology by personnel can be useful in this regard.

P36 The Impact of COVID-19 Diagnosis on Healthcare Costs

P36 The Impact of COVID-19 Diagnosis on Healthcare Costs

P44 Multiple Myeloma Total Direct Costs in Colombia: A National Cohort Study Based on Administrative Claims Databases

Multiple myeloma (MM) is associated with a substantial economic burden for health systems worldwide, however, evidence regarding this burden in middle-income countries is lacking. Colombia, a middle-income country, provides healthcare services included and not included in its Health Benefit Package (HBP and non-HBP services, respectively) to its population through several insurance regimes. Almost 48% of Colombian population receive healthcare services through the contributory regime. This study aims to describe the costs of healthcare services delivered to patients with MM affiliated with the contributory regime in 2018.

Reported costs of children with medical complexity-A systematic review.

Examining reported costs for Children with Medical Complexity (CMCs) is essential because costing and resource utilization studies influence policy and operational decisions. Our objectives were to (1) examine how authors identified CMCs in administrative databases, (2) compare reported costs for the CMC population in different study settings, and (3) analyze author recommendations related to reported costs. We undertook a systematic search of the following databases: Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library with a focus on CMCs as a heterogeneous group. The most common method used n = 11 (41%) to identify the CMC population in administrative data was the Complex Chronic Conditions methodology. The majority of included studies reported on health care service costs n = 24 (89%). Only n = 3 (11%) of the studies included costs from the family perspective. Author recommendations included standardizing how costs are reported and including the family perspective when making care delivery or policy decisions. Health system administrators and policymakers must consider the limitations of reported costs when assessing local costing studies or comparing costs across jurisdictions.

Impact of enhanced recovery implementation in women undergoing abdominal sacrocolpopexy.

To assess the effect of Enhanced Recovery After Surgery (ERAS) with and without liposomal bupivacaine (LB) on opioid use, hospital length of stay (LOS), costs, and morbidity of women undergoing sacrocolpopexy. Retrospective cohort of women who underwent abdominal sacrocolpopexy between April 1, 2009 and November 30, 2017. Costs for relevant healthcare services were determined by assigning 2017 charges multiplied by 2017 Medicare Cost Report's cost to charge ratios. Outcomes were compared among periods with multivariable regression models adjusted for age, American Society of Anesthesiologists score, and concurrent hysterectomy and posterior repair. Patients were subdivided into pre-ERAS (G1, n= 128), post-ERAS (G2, n= 83), and post-ERAS plus LB (G3, n= 91). The proportion of patients needing opioids during postoperative days 0-2 was significantly less for G3 (75.8%) compared with G1 (97.7%) and G2 (92.8%); P< 0.001). The median morphine equivalent units (MEU) with interquartile ranges, mean LOS, and adjusted mean standardized costs were significantly lower in G3 compared with the other two groups (35 [20-75] vs. 67 [31-109], and 60 [30-122] MEUs; 1.8 vs. 2.3 vs. 2.9 days; and $2391, $2975, and $3844, for G3, G2, and G1, respectively; P< 0.001). Implementation of an ERAS pathway led to significant decreases in opioid use, LOS, and costs. Supplementation with LB further improved these measures.

Pediatric Research Challenge, Alignment with the National Research Agenda

Pediatric Research Challenge, Alignment with the National Research Agenda

Patient-reported outcome is associated with health care costs in patients with ischaemic heart disease and arrhythmia.

Systematic use of patient-reported outcomes (PROs) have the potential to improve quality of care and reduce costs of health care services. We aimed to describe whether PROs in patients diagnosed with heart disease are directly associated with health care costs. A national cross-sectional survey including PROs at discharge from a heart centre with 1-year follow-up using data from national registers. We included patients with either ischaemic heart disease (IHD), arrhythmia, heart failure (HF), or valvular heart disease (VHD). The Hospital Anxiety and Depression Scale, the heart-specific quality of life, the EuroQol five-dimensional questionnaire, and the Edmonton Symptom Assessment Scale were used. The economic analysis was based on direct costs including primary, secondary health care, and medical treatment. Patient-reported outcomes were available from 13 463 eligible patients out of 25.241 [IHD (n = 7179), arrhythmia (n = 4322), HF (n = 987), or VHD (n = 975)]. Mean annual total direct costs in all patients were €23 228 (patients with IHD: €19 479, patients with arrhythmia: €21 076, patients with HF: €34 747, patients with VDH: €48 677). Hospitalizations contributed overall to the highest part of direct costs. For patients discharged with IHD or arrhythmia, symptoms of anxiety or depression, worst heart-specific quality of life or health status, and the highest symptom burden were associated with increased economic expenditure. We found no associations in patients with HF or VHD. Patient-reported outcomes at discharge from a heart centre were associated with direct health care costs in patients with IHD and arrhythmia. ClinicalTrials.gov: NCT01926145.

Clustering Diagnoses From 58 Million Patient Visits in Finland Between 2015 and 2018.

BackgroundMultiple chronic diseases in patients are a major burden on the health service system. Currently, diseases are mostly treated separately without paying sufficient attention to their relationships, which results in the fragmentation of the care process. The better integration of services can lead to the more effective organization of the overall health care system.ObjectiveThis study aimed to analyze the connections between diseases based on their co-occurrences to support decision-makers in better organizing health care services.MethodsWe performed a cluster analysis of diagnoses by using data from the Finnish Health Care Registers for primary and specialized health care visits and inpatient care. The target population of this study comprised those 3.8 million individuals (3,835,531/5,487,308, 69.90% of the whole population) aged ≥18 years who used health care services from the years 2015 to 2018. They had a total of 58 million visits. Clustering was performed based on the co-occurrence of diagnoses. The more the same pair of diagnoses appeared in the records of the same patients, the more the diagnoses correlated with each other. On the basis of the co-occurrences, we calculated the relative risk of each pair of diagnoses and clustered the data by using a graph-based clustering algorithm called the M-algorithm—a variant of k-means.ResultsThe results revealed multimorbidity clusters, of which some were expected (eg, one representing hypertensive and cardiovascular diseases). Other clusters were more unexpected, such as the cluster containing lower respiratory tract diseases and systemic connective tissue disorders. The annual cost of all clusters was €10.0 billion, and the costliest cluster was cardiovascular and metabolic problems, costing €2.3 billion.ConclusionsThe method and the achieved results provide new insights into identifying key multimorbidity groups, especially those resulting in burden and costs in health care services.

Growth and Development of Health Insurance in India

A person or a group can acquire health insurance in advance after paying a charge known as a "premium." It is an additional funding source for expanding access to high-quality healthcare. Health insurance products is offered by general insurance and life insurance companies in India. A nation's health indicators are evaluated using factors such as fatality rate, pregnancy-related death. Since independence, India has made significant progress in every sector. However, according to the 11th Plan, the country's healthcare services cost was higher in private industry than in the public sector. To lighten the burden on the poor, a study group formed by the Ministry of Health recommended investigating a risk pooling scheme. This paper is based on growth and development of health insurance in India. Secondary data has been used for the study purpose and collected from various sources. This study is completely based on secondary data. The data was collected from reports published by WHO, IRDA, research articles and review articles pertaining to the health insurance industry in India. The market for health insurance in India is primarily untapped. The main target population is the medium-income group, which provides the brightest future for this industry.Classification-JEL: I12, I13

Assessing Nurses’ Workplace Social Capital: A Study Protocol for Culturally Appropriate Instrument Development

Workplace social capital positively influences the quality but reduces the cost of healthcare services. Academic research suffers from limited and inadequate culturally sensitive nurses’ workplace social capital instruments. Here we report on the design and protocol of a culturally focused instrument development study in China. The overarching objective of our dual phase study is to develop and validate a questionnaire measuring nurses’ workplace social capital tailored toward Chinese cultural values and norms. In the first phase of INSTRUMENT DEVELOPMENT, the qualitative phase, we will conduct interviews with purposefully sampled nurses from five geographically diverse regions capturing 16 provinces in China to formulate the initial version of the Nurses’ Workplace Social Capital Questionnaire (NWSCQ). Data collection will be stopped at the saturation point and content analysis will be performed for interview data in parallel. The initial version of the NWSCQ will be evaluated and confirmed by two-rounds of expert consultation (target N = 20) and pre-tested among 70 nurses. During the second phase of INSTRUMENT VALIDATION or the quantitative phase, we will validate the psychometric properties of the NWSCQ. The validity and reliability of the questionnaire will be examined and validated through three cross-sectional surveys among nurses (target N = 1154) randomly selected from 12 tertiary hospitals. We have reported our study protocol with the intention of sharing our experience with researchers in other countries who are striving to advance the phenomenon of culturally sensitive and social normatively appropriate nurses’ workplace social capital. Findings from our study should advance the development of culturally appropriate and valid instrument of nurses’ workplace social capital, another important step toward recognition and incorporation of cultural diversity in the daily operation of healthcare industry.

In Search for Comparability: The PECUNIA Reference Unit Costs for Health and Social Care Services in Europe.

Improving the efficiency of mental healthcare service delivery by learning from international best-practice examples requires valid data, including robust unit costs, which currently often lack cross-country comparability. The European ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) aimed to harmonize the international unit cost development. This article presents the methodology and set of 36 externally validated, standardized reference unit costs (RUCs) for five health and social care services (general practitioner, dentist, help-line, day-care center, nursing home) in Austria, England, Germany, Hungary, The Netherlands, and Spain based on unambiguous service definitions using the extended DESDE PECUNIA coding framework. The resulting PECUNIA RUCs are largely comparable across countries, with any causes for deviations (e.g., country-specific scope of services) transparently documented. Even under standardized methods, notable limitations due to data-driven divergences in key costing parameters remain. Increased cross-country comparability by adopting a uniform methodology and definitions can advance the quality of evidence-based policy guidance derived from health economic evaluations. The PECUNIA RUCs are available free of charge and aim to significantly improve the quality and feasibility of future economic evaluations and their transferability across mental health systems.

Understanding the Economic Impact of an Essential Service: Applying Time-Driven Activity-Based Costing to the Hospital Airway Response Team.

As the United States moves toward value-based care metrics, it will become essential for anesthesia groups nationwide to understand the costs of their services. Time-driven activity-based costing (TDABC) estimates the amount of time it takes to perform a clinical activity by dividing complex tasks into process steps and mapping each step and has historically been used to estimate the costs of various health care services. TDABC is a tool that can be adapted for variable staffing models and the volume of service provided. Anesthesia departments often provide staffing for airway response teams (ART). The economic implications of staffing ART have not been well described. We present a TDABC model for ART activation in a tertiary-care center to estimate the cost incurred by an anesthesiology department to staff an ART. Pages received by the Brigham and Women's Hospital ART over a 24-month time period (January 2019 to December 2020) were analyzed and categorized. The local administrative database was queried for the Current Procedural Terminology (CPT) code used to bill for emergency airway placements. Sessions were held by multiple members of the ART to create process maps for the different types of ART activations. We estimated the staffing costs using the estimated time it took for each type of ART activation as well as the data collected for local ART activations. From the paging records, we analyzed 3368 activations of the ART. During the study period, 1044 airways were billed for with emergency airway CPT code. The average revenue collected per airway was $198.45 (95% CI, $190-$207). For STAT/Emergency airway team activations, process maps and non-STAT airway team activations were created, and third subprocess map was created for performing endotracheal intubation. Using the TDABC, the total staffing costs are estimated to be $218,601 for the 2-year study period. The ART generated $207,181 in revenue during the study period. Our analysis of ART-activation pages suggests that while the revenue generated may cover the cost of staffing the team during ART activations, it does not cover consumable equipment costs. Additionally, the current fee-for-service model relies on the team being able to perform other clinical duties in addition to covering the airway pager and would be impossible to capture using traditional top-down costing methods. By using TDABC, anesthesia groups can demonstrate how certain services, such as ART, are not fully covered by current reimbursement models and how to negotiate for subsidy agreements.As the transition from traditional fee-for-service payments to value-based care models continues in the United States, improving the understanding and communication of medical care costs will be essential. In the United States, it is common for anesthesia groups to receive direct revenue from hospitals to preserve financial viability, and therefore, knowledge of true cost is essential regardless of payer model.1 With traditional payment models, what is billable and nonbillable may not reflect either the need for or the cost of providing the service. As anesthesia departments navigate the transition of care from volume to value, actual costs will be essential to understand for negotiations with hospitals for support when services are nonbillable, when revenue from payers does not cover anesthesia costs, and when calculating the appropriate share for anesthesia departments when bundled payments are distributed.

Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial

BackgroundTraumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.MethodsOne-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER).ResultsThe mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU.ConclusionsCosts associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.Trial registrationClinicalTrails.gov NCT03092713.

Sustainable and Robust Home Healthcare Logistics: A Response to the COVID-19 Pandemic

Today, research on healthcare logistics is an important challenge in developing and developed countries, especially when a pandemic such as COVID-19 occurs. The responses required during such a pandemic would benefit from an efficiently designed model for robust and sustainable healthcare logistics. In this study, we focus on home healthcare logistics and services for planning the routing and scheduling of caregivers to visit patients’ homes. Due to the need for social distancing during the COVID-19 pandemic, these services are highly applicable for reducing the growth of the epidemic. In addition to this challenge, home healthcare logistics and services must be redesigned to meet the standards of a triple bottom line approach based on sustainable development goals. A triple bottom line approach finds a balance between economic, environmental, and social criteria for making a sustainable decision. Although, recently, the concept of green home healthcare has been studied based on the total cost and green emissions of home healthcare logistics and services, as far as we know, no research has been conducted on the formulation of a triple bottom line approach for home healthcare logistics and services. To achieve social justice for caregivers, the goal of balancing working time is to find a balance between unemployment time and overtime. Another contribution of this research is to develop a scenario-based robust optimization approach to address the uncertainty of home healthcare logistics and services and to assist with making robust decisions for home healthcare planning. Since our multi-objective optimization model for sustainable and robust home healthcare logistics and services is more complex than other studies, the last novel contribution of this research is to establish an efficient heuristic algorithm based on the Lagrangian relaxation theory. An initial solution is found by defining three heuristic algorithms. Our heuristic algorithms use a symmetric pattern for allocating patients to pharmacies and planning the routing of caregivers. Then, a combination of the epsilon constraint method and the Lagrangian relaxation theory is proposed to generate high-quality Pareto-based solutions in a reasonable time period. Finally, an extensive analysis is done to show that our multi-objective optimization model and proposed heuristic algorithm are efficient and practical, as well as some sensitivities are studied to provide some managerial insights for achieving sustainable and robust home healthcare services in practice.

A Physical Therapy Mobility Checkup for Older Adults: Feasibility and Participant Preferences From a Discrete Choice Experiment.

Physical performance measures, like walking speed, identify and predict preclinical mobility disability but are rarely used in routine medical care. A preventive model of care called Mobility Checkup is being designed to reduce mobility disability in older adults. This study had two purposes: 1) determine feasibility and outcomes of the Mobility Checkup, and 2) identify preferences of older adults regarding this model of care using a discrete choice experiment. Adults over 55 years of age were recruited from the community. In the study's first phase, participants completed a Mobility Checkup, with feasibility evaluated using 6 criteria. In the second phase, a new sample of older adults (>55 years old) were educated about the Mobility Checkup and then completed a discrete choice experiment to determine their preferences regarding 4 attributes of this care model: cost, visit duration, desired education topic, and style of educational graphic. Each study phase was completed by 31 participants. Of the 6 feasibility criteria, 5 were met. Visit duration exceeded the 60-minute criteria for 13 of the 31 participants. Still, 91% of participants were very satisfied with the Mobility Checkup. Ability to transition positions identified preclinical mobility disability most frequently. A 30-minute visit with no out-of-pocket cost was deemed preferred. Older adults value knowing what physical performance measurements predict about their general health. Transitions should be evaluated as part of a Mobility Checkup for older adults. Clearly conveyed cost of health care service is important to older adult consumers.

Cost of Hepatitis C care facilitation for HIV/Hepatitis C Co-infected people who use drugs

BackgroundUsing data from a randomized trial, we evaluated the cost of HCV care facilitation that supports moving along the continuum of care for HIV/HCV co-infected individuals with substance use disorder. MethodsParticipants were HIV patients residing in the community, initially recruited from eight US hospital sites. They received HCV care facilitation (n = 51) or treatment as usual (n = 62) for up to six months. We used micro-costing methods to evaluate costs from the healthcare sector and patient perspectives in 2017 USD. We conducted sensitivity analyses varying care facilitator caseloads and examined offsetting savings using participant self-reported healthcare utilization. ResultsThe average site start-up cost was $6320 (site range: $4320-$7000), primarily consisting of training. The mean weekly cost per participant was $20 (site range: $4-$30) for care facilitation visits and contacts, $360 (site range: $130- $700) for supervision and client outreach, and $70 (site range: $20-$180) for overhead. In sensitivity analyses applying a weekly caseload of 10 participants per care facilitator (versus 1–6 observed in the trial), the total mean weekly care facilitation cost from the healthcare sector perspective decreased to $110. Weekly participant time and travel costs averaged $7. There were no significant differences in other healthcare service costs between participants in the intervention and control arms. ConclusionWeekly HCV care facilitation costs were approximately $450 per participant, but approximately $110 at a real-world setting maximum caseload of 10 participants per week. No healthcare cost offsets were identified during the trial period, although future savings might result from successful HCV treatment.

Trends in Characteristics of Adults Enrolled in Traditional Fee-for-Service Medicare and Medicare Advantage, 2011-2019.

While overall Medicare Part C (Medicare Advantage) enrollment has grown more rapidly than fee-for-service Medicare enrollment, changes in the growth and characteristics of different enrollee populations have not been examined. For 2011-2019, to compare changes in the growth and characteristics of younger (age younger than 65) and older (age 65 and older) Medicare beneficiaries enrolled in Medicare Part A only, Medicare Parts A & B, and Medicare Part C. This was a retrospective, observational study. Medicare beneficiaries who were alive and enrolled in Medicare Part A only, Medicare Parts A & B, or Medicare Part C on June 30 of each year and in no other plan that year. For each plan type and age group the numbers and mean ages of enrollees and the proportion of enrollees who were: black, female, concurrently enrolled in Medicaid, and (for older enrollees), whose initial reason for eligibility was old age and survivors' benefits. Between 2011 and 2019, Medicare Part C experienced rapid expansions of 85.0% among older and 109.5% among younger enrollees. Part C enrollees were increasingly likely to be dually enrolled in Medicaid, Black and, among younger enrollees, female. Trends in demographic characteristics and changes in policy and growth in employer group plan offerings will likely continue to impact health care service utilization and costs in the Medicare population. Particularly as Medicare expansion to younger age groups is considered, future research should explore disparities in risk scores and care equity, quality, and costs across different Medicare enrollment options.