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Medicare and Medicaid Costs for Schizophrenia Patients by Age Cohort Compared With Costs for Depression, Dementia, and Medically Ill Patients

Received August 22, 2003; revised August 27, 2003; accepted September 4, 2003. From the Departments of Psychiatry (SJB,REC) and Community and Family Medicine (REC), Dartmouth Medical School, Lebanon, NH, and the New Hampshire–Dartmouth Psychiatric Research Center (SJB,REC,WJP,ARD,SIP), Dartmouth Medical School, Lebanon and Concord, NH. Send correspondence to Stephen J. Bartels, M.D., M.S., New Hampshire–Dartmouth Psychiatric Research Center, 2 Whipple Place, Suite 202, Lebanon, NH 03766. e-mail: stephen.j.bartels{at}dartmouth.edu

Objective: The authors describe per-capita Medicaid and Medicare expenditures across age cohorts for individuals with schizophrenia and compare expenditures for patients with schizophrenia and those with depression, dementia, and non-psychiatric medical disorders. Methods: Medicaid and Medicare claims were identified for dually-eligible beneficiaries ages 19+ in New Hampshire during 1999 (schizophrenia: N=1,423; depression: N=2,219; dementia: N=1,942; medical disorders alone: N=4,260). Annual per-capita weighted average expenditures were calculated for inpatient, outpatient, home-health, nursing home, pharmacy, physician, and other services. Results: The greatest per-capita expenditures for individuals with schizophrenia were among older beneficiaries ($39,154 for ages 65–74 and $43,461 for ages 75+), versus younger beneficiaries ($25,633 for ages 19–44 and $31,529 for ages 45–64). Outpatient services were the highest expenditure among younger adults (ages 19–64), whereas nursing home services were the highest expenditure for ages 65+. Total expenditures for individuals with schizophrenia exceeded those for individuals with depression, dementia, or medical disorders across all age cohorts except age 45–64, where dementia expenditures were highest. Among individuals age 65–74, per-capita expenditures for schizophrenia were $11,304 higher than for depression and $28,256 higher than for medical disorders. Conclusion: Schizophrenia is one of the most expensive disorders across the adult lifespan, and expenditures increase across age cohorts. Effective interventions are needed that improve independent functioning in older age, in conjunction with innovative models of home- and community-based services that decrease high use of and expenditures for nursing homes.

Key Words: Schizophrenia • Quality of Life • Healthcare Costs • Medicare • Medicaid