Cross-State Variation in Health Care Utilization of the DI Population: Evidence from Medicare Claims

Beneficiaries in the Social Security Disability Insurance program are enrolled in Medicare after 24 months on the program. Using 100 percent Medicare Part B claims in 2012 for people under age 65, I examine office and outpatient visits by state and by primary diagnosis for the visit. The per capita number of visits by state, based on the number of Medicare Part B enrollees under age 65 in each state, reveals substantial cross-state variation in the use of health care by DI beneficiaries. Across the United States, the average number of office and outpatient visits per capita was about 24 in 2012, or 2 per month, but it ranged from almost 39 in Vermont to 14 in Hawaii. Visits for musculoskeletal impairments averaged 3.4 per capita, ranging from 5.6 in Delaware to 1.4 in Hawaii. The greatest variation occurred in visits for mental health conditions, averaging 2.4 for the U.S. but ranging from 7.4 in Massachusetts to 1.0 in Arizona. Factors such as the share of a state’s population who are obese, the share of a state’s Medicare population with Medicare Advantage plans, and drug prescribing rates help to explain a sizable portion of the variation in health care utilization across states. Knowledge of health care utilization could inform policy choices for programs such as return-to-work strategies or early intervention efforts both at the federal level and tailored to particular needs at the state level.