Who Provides Care to Medicare Beneficiaries?
Background: Concerns have been expressed that the physician workforce is unprepared for the explosion in the number of older persons in America. As a step toward informing these discussions, this article will describe how Medicare beneficiaries currently access physician services.
Methods: This study is a descriptive analysis of the physician services used by Medicare beneficiaries. The Medicare Beneficiary Survey (MCBS) data from 1998 are used for the analysis. The locations of service delivery were compared among family physicians, general internists, and geriatricians.
Results: The physician office was the most common site of service, comprising 49% of all provider claims. General internists (20.1% of office claims) and family physicians (18.6% of office claims) were the most common providers. Family physicians spent the largest proportion of their time in the office (77%), general internists were the most likely provider to see patients in the hospital (19%), and geriatricians were the most likely to see patients in the nursing home (27%) and at home (1.7%).
Conclusions: Office-based care by general internists and family physicians constitute a major infrastructure element in the delivery of care to Medicare beneficiaries. The practices of geriatric medicine physicians are more heavily weighted toward the nursing home setting.
Concerns have been expressed that the physician workforce is unprepared for the explosion in the number of older persons in America. In this age wave, what role will the primary care physiciansgeneral internists and family physiciansplay in caring for older persons. At the moment, only 1% of graduates from American medical schools choose geriatrics as a career, assuring a central role for both general internal medicine and family medicine in caring for older persons. In this environment, how will geriatric medicine physicians interface with the primary care disciplines of family medicine and internal medicine?
One necessary step toward answering these questions is to understand who is providing care to patients over age 65 right now. This article describes how Medicare beneficiaries currently access physician services. It will describe the beneficiaries' current use of physician services and locations at which they currently receive care.