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Age and race are associated with receipt of Medicare-funded outpatient care among people with schizophrenia

Schizophrenia affects 1 percent of people in the United States, accounts for 25 percent of all hospital days, and costs the Nation $30-$40 billion each year. For a chronic, debilitating illness such as schizophrenia, underuse of outpatient care services increases the risk of crisis-oriented care. Yet only one-fourth of schizophrenics with Medicare coverage received any outpatient care in 1991.

Black and older schizophrenics covered by Medicare received less outpatient care than white and younger schizophrenics, according to a study conducted by the Schizophrenia Patient Outcomes Research Team (PORT). The PORT was supported by the Agency for Healthcare Research and Quality (PORT contract 290-92-0054), and led by Anthony Lehman, M.D., M.S.P.H., of the University of Maryland School of Medicine.

The researchers analyzed 1991 data on 12,440 schizophrenia-related Medicare claims. They found that being male, black, 65 years of age or older, and having a substance abuse diagnosis were associated with a lower likelihood of receiving any outpatient care service. Among people under 65 years of age, whites were about 1.5 times as likely as blacks to have received outpatient care and 1.3 times as likely to have received individual therapy. Men and women 65 years of age or older (for whom symptoms are usually less severe) were about half as likely to have received any services, including individual, group, or family therapy. Among all those receiving Medicare-funded care, the costs of care were lower for blacks and for older people.

The most frequently used type of therapy was individual therapy, followed by somatotherapy (biological therapy), group therapy, and family therapy. For blacks, the likelihood of receiving individual therapy was 74 percent that of whites. People who received individual therapy tended to be younger than 65, to be female, to have additional psychiatric illnesses, and to be covered by Medicare only. The lower rates of individual therapy among those covered by both Medicare and Medicaid may reflect the substitution of other Medicaid services for individual therapy, such as case management and rehabilitation.

See "Use and costs of ambulatory care services among Medicare enrollees with schizophrenia," by Lisa Dixon, M.D., M.P.H., Alan Lyles, Sc.D., M.P.H., Corey Smith, M.A., and others, in the June 2001 Psychiatric Services 52(6), pp. 786-792.

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