与医疗保险医生组实践演示相关的支出差异.
Carrie H Colla1, David E Wennberg, Ellen Meara
1Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 35 Centerra Pkwy, Lebanon, NH 03766, USA. Carrie.H.Colla@Dartmouth.edu
JAMA
|September 13, 2012
概括
医疗保险医生小组实践演示 (PGPD) 显示了适度的整体成本节省,而显著的节省集中在双重符合医疗保险和医疗补助的受益人身上. 一些参与的医生团队实现了大幅度的节约,而另一些则没有.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 改善医疗保健的质量
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 推出了问责护理组织 (ACO) 计划,以提高医疗保健质量和管理成本.
- 医疗保险医生小组实践示范 (PGPD) 试点项目在ACO之前,为医生小组实现质量目标和降低成本提供了财政激励.
- 虽然PGPD显示质量改善,但其对医疗保健成本的影响仍然不确定.
研究的目的:
- 为了确定PGPD的整体成本节约.
- 具体估计医疗保险和医疗补助双重资格的受益人节省的成本.
主要方法:
- 采用了准实验性设计,比较了干预前 (2001-2004) 和干预后 (2005-2009) 的支出趋势.
- 干预组包括990,177名由PGPD医生治疗的收费医疗保险受益者;对照组包括来自同一地区的7,514,453名受益者.
- 每位受益者的年度支出是主要的结果衡量标准,用于案例组合分析的各种风险调整方法.
主要成果:
- 总体而言,每位受益人的年度储蓄是适度的 (调整后的平均值为114美元).
- 对于双重资格的受益者 (调整后的平均值为532美元) 观察到显著的节省,但对于非双重资格的受益者则没有.
- 支出减少主要是急性护理,参与医生群体的储蓄有显著差异.
结论:
- 在一些机构中,PGPD实现了大幅度的节约,但这被其他机构缺乏节约所抵消.
- 大多数节省成本的受益人是符合医疗保险和医疗补助双重资格的受益人.
- 调查结果突出了基于实践的支付模式对医疗保健支出的影响.
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