Factors associated with psychotropic prescriptions, psychiatric hospitalization, and spending among Medicare beneficiaries under 65

BackgroundMedicare beneficiaries under 65 are a medically heterogenous population with significant psychiatric health service utilization. Patterns of psychiatric health services utilization and spending have not been well studied in this population.ObjectiveTo estimate and compare annual trends in psychotropic prescriptions, psychiatric hospitalization, and total Medicare spending between Medicare beneficiaries <65 and those ≥65. We also identified factors associated with these outcomes among Medicare beneficiaries under 65.MethodsThis serial cross-sectional study used 2006-2009 Medicare Current Beneficiary Survey (MCBS) data linked with Medicare claims. Psychotropic prescription and psychiatric hospitalization were measured using claims data. Total annual Medicare spending included reimbursements from Medicare Parts A, B, and D. Repeated person-year data were analyzed using generalized estimating equation (GEE) models to examine associations between factors and outcomes among beneficiaries <65, controlling for covariates.ResultsOver one-third of beneficiaries <65 used at least one psychotropic prescription annually. Annual prevalence of psychotropic prescription and psychiatric hospitalization was higher among beneficiaries <65 than those ≥65 (threefold and ten-fold, respectively), as well as Medicare spending. The annual prevalence of psychiatric hospitalization decreased over time among beneficiaries <65. Antidepressants were the most prevalently prescribed psychotropic drug class among beneficiaries <65. Factors associated with psychiatric services utilization and spending among beneficiaries <65 included demographics and health insurance access, self-reported health, smoking status, and comorbidities (all P < 0.05).ConclusionsOur findings highlight the special psychiatric health care needs of Medicare beneficiaries under 65 and call for the attention of policy makers and clinicians to this understudied population.