Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Medical Care Expenditures


The final analysis of medical care use examines expenditures made for physician services, outpatient departments, and the aggregation of these services into combined medical care services. Unadjusted monthly Medical care service expenditures averaged over the recipients’ IHSS eligibility months in 2005 are shown in Table 24. This table has three panels, one with data for all recipients, one for recipients continuing from 2004, and those newly entering IHSS in 2005. The table combines both physician services and those of outpatient departments.35

Within recipient age groups there is little difference in the average monthly expenditures for physician and outpatient department services among the provider groups. Average monthly Medicaid expenditures tend to be highest for children, lowest for those 65 or older. Combining the sources of medical care, the mean monthly expenses for IHSS from recipients age 3-17 continuing from 2004, range from a $140-$180 across all provider groups; the ranges are respectively $105-$170 among those age 18-64, and $40-$50 among those age 65 or more. The lower expenditures among adults, and the aged in particular, are likely due to Medicare or another source being a primary payer on these services. Expenditures for those who enter the IHSS program are marginally higher than for continuing recipients. This may be associated with instability in service needs that predated enrollment in IHSS. However, the underlying causes cannot be determined from the study’s single year of data.

Table 25 uses ordinary least squares regression to adjust for recipient characteristics in evaluating recipient mean expenditure differences among provider and race/ethnicity groups. Expenditures are inclusive of all physician and outpatient department claims during the calendar year for those continuing as an IHSS recipient from 2004, and after the date of IHSS eligibility in 2005 for new recipients. Expenditures are in dollar units divided by 1,000.36 The predicted difference in recipient expenditure levels associated with the provider group measures is generally modest. For minor children there are no statistically significant differences between the estimated expenditures for Parent or Other Relative providers and Non-Relatives. Among non-aged adult recipients, those with either Spouse or Other Relative providers have about $14 lower average monthly expenditures than Non-Relatives. Expenditures for those with Parent providers are not statistically different from those of Non-Relatives. Among recipients aged 65+, there are no adjusted differences between recipients with IHSS-paid Spouse or Other Relative providers and Non-Relative providers.

Returning to the issue of equality of medical care access by race/ethnic groups, the coefficients for the race/ethnicity groups regressed on medical care expenditures are generally not statistically different from those of Whites. The most important differences are that Black Adults have lower average monthly expenditures than Whites. This difference, as in the earlier analysis, may be explained by lower use medical care use by Black. New enrollees into IHSS in 2005 tend to have higher average adjusted monthly expenses than continuing recipients. Whether this is a function of ongoing problems or only those associated with the reasons for entering the program have not been determined.

  1. Separate tables showing unadjusted results for physician service use and outpatient department use can be found in Appendix D.

  2. Separate models were also run using interaction main effects, but these did not significantly change the model goodness of fit and have not been used.

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