Utilization and cost of ambulatory care services of medicaid recipients, Bronx

Abstract

The Bronx Professional Standards Review Organization (BPSRO) analyzed 1979-80 ambulatory claims for South Bronx Medicaid recipients. An estimated 87 per cent of Medicaid eligibles were users of care with an average of 11.2 visits a year, compared to an average of 9.8 visits for the Bronx Medicaid population. Shared Health Facilities (Medicaid Mills) were the principle providers of care. Two-thirds of the costs were generated by one-fourth of the patients who made more than 10 visits each a year, BPSRO concluded the South Bronx does not lack health care resources for the Medicaid recipient and that public policy and patients would benefit by concentrating reforms on high utilizers and provision of care for the near poor.