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Who Provides Care to Medicare Beneficiaries and What Settings Do They Use?

From the Department of Family & Community Medicine, University of California, Davis

Correspondence: Address correspondence to George C. Xakellis, MD, Department of Family & Community Medicine, University of California Davis Medical Center, 4860 Y Street, Room 2335, Sacramento, CA 95819 (e-mail: george.xakellis{at}ucdmc.ucdavis.edu)

Abstract

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.