Diagnosed prevalence and health care expenditures of mental health disorders among dual eligible older people

Terry Y. Lum, Shriram Parashuram, Tetyana P. Shippee, Andrea Wysocki, Nathan D. Shippee, Patricia Homyak, Robert L. Kane

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Purpose: Little is known about mental health disorders (MHDs) and their associated health care expenditures for the dual eligible elders across long-term care (LTC) settings. We estimated the 12-month diagnosed prevalence of MHDs among dual eligible older adults in LTC and non-LTC settings and calculated the average incremental effect of MHDs on medical care, LTC, and prescription drug expenditures across LTC settings. Methods: Participants were fee-for-service dual eligible elderly beneficiaries from 7 states. We obtained their 2005 Medicare and Medicaid claims data and LTC program participation data from federal and state governments. We grouped beneficiaries into non-LTC, community LTC, and institutional LTC groups and identified enrollees with any of 5 MHDs (anxiety, bipolar, major depression, mild depression, and schizophrenia) using the International Classification of Diseases Ninth Revision codes associated with Medicare and Medicaid claims. We obtained medical care, LTC, and prescription drug expenditures from related claims. Results: Thirteen percent of all dual eligible elderly beneficiaries had at least 1 MHD diagnosis in 2005. Beneficiaries in non-LTC group had the lowest 12-month prevalence rates but highest percentage increase in health care expenditures associated with MHDs. Institutional LTC residents had the highest prevalence rates but lowest percentage increase in expenditures. LTC expenditures were less affected by MHDs than medical and prescription drug expenditures. Implications: MHDs are prevalent among dual eligible older persons and are costly to the health care system. Policy makers need to focus on better MHD diagnosis among community-living elders and better understanding in treatment of MHDs in LTC settings.

Original languageEnglish (US)
Pages (from-to)334-344
Number of pages11
Issue number2
StatePublished - Apr 2013

Bibliographical note

Funding Information:
This work was supported by the Centers for Medicare and Medicaid Services under Contract No. MRAD HHSM-500-2005-000271 Task Order #1 “Monitoring Chronic Disease Care and Outcomes Among Elderly: Extending the Use of MAX to Examine Rebalancing.”


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