A diagnosis of Parkinson’s disease is associated with greater Medicare costs and out-of-pocket spending, according to a population-based study in the U.S.
These findings also revealed substantial geographic variation in prevalence and health service use and spending among Medicare beneficiaries.
The study, “State-level prevalence, health service use, and spending vary widely among Medicare beneficiaries with Parkinson disease,” appeared in the journal npj Parkinson’s Disease.
State-level variations in clinical outcomes, disease prevalence and healthcare use, quality and spending among Medicare beneficiaries have influenced healthcare planning at both federal and state levels. In the U.S., healthcare and reimbursement are being governed at the state level more and more.
“Medicare is a federally administered program providing health insurance to individuals over the age of 65, while Medicaid, which provides coverage to individuals below the poverty line, is funded by individual states,” the researchers wrote in the study.
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Parkinson’s patients on Medicare often qualify for Medicaid due to having to spend more on healthcare and/or long-term care associated with the disease. However, Medicare remains the main payer for office visits, hospitalizations, home care, and nursing facility assistance for individuals older than 65 who are considered dual-eligible, meaning they are covered by both Medicare and Medicaid.
Data on how Parkinson’s care and spending vary across the U.S. are lacking. This information would help guide health policy and planning in a time when the prevalence of Parkinson’s is increasing with the aging population, as shown by the Parkinson’s Foundation’s Parkinson’s Prevalence Project, which estimates that 1.2 million people will be living with the disease by 2030.
To address this lack of information, the current Parkinson’s Foundation study looked at differences among states in disease prevalence, patient characteristics, spending, out-of-pocket costs, and health service use for 27.5 million Medicare beneficiaries in 2014.
The analysis found 392,214 individuals diagnosed with Parkinson’s nationwide. New York, Connecticut, Florida, District of Columbia, and Rhode Island had the highest prevalence, encompassing 20.7% of all Parkinson’s patients on Medicare.
Among the potential reasons for the higher prevalence in these states, the researchers cite a possible “larger proportion of high-risk factor patient groups, a higher concentration of providers who recognize and document [Parkinson’s], increased public awareness of [Parkinson’s] symptoms, or increased health care seeking behaviors.”
Women represented 45.8% of the total number of Parkinson’s patients on Medicare. West Virginia, Kentucky, Mississippi, Louisiana and Arkansas had the largest proportions of women, each with more than 48.5%.
“Although women diagnosed with [Parkinson’s] are a sizable portion of the patient population, they are highly underrepresented in [Parkinson’s] research and clinical trials,” said Allison W. Willis, MD, the study’s senior author. Willis, a professor at the Perelman School of Medicine at the University of Pennsylvania, added that more attention needs to be paid to women, who have less access to specialized care, to improve disease outcomes.
In addition, the data showed that 26.1% of the patients were 85 years or older. Connecticut (33.2%), Pennsylvania (31.2%), Hawaii (31.2%), and Rhode Island (31.1%) were the states with the highest proportions of this age group.
Dual-eligible patients made up less than 10% of the total patients in North Dakota, Minnesota, New Hampshire, Arizona, Wisconsin and Utah, but more than 25% in Connecticut, Maine, Mississippi, California, and the District of Columbia.
Throughout 2014, Parkinson’s patients on Medicare had 219,049 hospitalizations, 37,839 readmissions, 3,699,767 outpatient doctor’s office visits, 34,159 hospice stays, 113,027 skilled nursing facility stays, 466,160 emergency room visits, 1,308,934 durable medical equipment events, 6,676,119 laboratory tests, 2,435,654 imaging assessments, and 4,879,538 home health visits.
Hospitalization rates were highest in New York, Michigan, Illinois, West Virginia and Florida, and lowest in Hawaii, Alaska, Utah, North Dakota, and Idaho. Readmission rates were highest in Florida, though with less variation by state.
Medicare paid nearly $7.9 billion for healthcare services for people with Parkinson’s. Inpatient care ($2.1 billion), skilled nursing facility care ($1.4 billion), hospital outpatient care ($881 million) and home health ($776.5 million) were the costliest services. For all services, Medicare and out-of-pocket spending were higher for beneficiaries with Parkinson’s than those without this disease.
Nevada, Texas, Massachusetts, Florida and New York were the top five states in spending, all greater than $22,000 per beneficiary with Parkinson’s. The highest out-of-pocket costs were found in the Great Lakes, Northeast, and South Central regions.
“Our study provides initial evidence that there is substantial geographic variation in health service use and spending for [Parkinson’s],” the researchers wrote.
“This state-level analysis will help inform policymakers on the societal costs of [Parkinson’s] and target areas where [Parkinson’s] patients may have more needs,” said James Beck, PhD, the Parkinson’s Foundation’s chief scientific officer. “We must realign our national priorities to support increased funding for research and care for people living with [Parkinson’s].”