Typology of High Users of Health Services Among a Rural Medicaid Population

• Published in: Public health Nursing 2009-09, Vol.26 (5), p.396-404
• Main Authors: Macnee, Carol L., McCabe, Susan, Clarke, Pamela N., Fiske, Marilyn, Campbell, Sara
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Databases as Topic; Demographics; Female; health care service use; Health services; Health Services Misuse; Humans; Male; Medicaid; Medicaid recipients; Medical sciences; Miscellaneous; Nurses; Nursing; over utilization; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rural health care; Rural Population; United States
• ISSN: 0737-1209; 1525-1446
• DOI: 10.1111/j.1525-1446.2009.00797.x

ABSTRACT Objectives: To identify a typology for high system users among a rural Medicaid population that could assist policy makers and providers in better and more efficiently serving this population. Design and Sample: Exploratory secondary data analysis of a large integrated Medicaid database in a western state. Five hundred and thirty‐nine Medicaid recipients receiving 2 or more state services and receiving 10 or more unique medications. Measures: Data analysis examining health care use, medication use, and demographic characteristics using SAS to identify patterns of use of services in the population. Results were confirmed with a statewide sample of 2,287 Medicaid users. Results: 3 characteristics—(1) use of 36 or more health care services in a year; (2) no gap in health care service use over the entire year; and (3) use of >12 health care services in 1 month—describe high‐risk groups of Medicaid users. Conclusions: Public health nurses, particularly as case managers and program planners, can look at service use patterns through client histories and their own agency records, in order to identify high‐risk groups who may benefit the most from programs that address their support, education, and coordination of health care needs.