可预防的急性护理支出对高成本医疗保险患者总支出的贡献
Karen E Joynt1, Atul A Gawande, E John Orav
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA. kjoynt@partners.org
JAMA
|June 26, 2013
概括
高成本的医疗保险患者推动了大量的医疗支出,但他们的成本的一小部分来自可预防的急诊室访问和住院治疗. 改善门诊护理可能对降低这一群体的整体成本的影响有限.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健管理的管理
- 公共卫生 公共卫生
背景情况:
- 一小部分美国患者占医疗保健支出的很大一部分.
- 了解高成本患者群体的支出模式对于降低成本至关重要.
- 在这些患者中,可预防的急性护理服务的程度尚不清楚.
研究的目的:
- 在高成本的医疗保险受益者中量化潜在可预防的急性护理服务的比例.
- 分析支出模式并确定节约成本干预的领域.
主要方法:
- 对2009-2010年5%的65岁以上受益人的医疗保险档案进行分析.
- 根据支出分数,识别高成本和持续高成本的患者.
- 应用算法来识别可能可以预防的急诊室 (ED) 访问和住院住院.
主要成果:
- 高成本的患者 (花费的前10%) 承担了32.9%的ED成本和79.0%的住院费用.
- 在高成本患者中,41.0%的ED费用和9.6%的住院费用是可以预防的.
- 持续高成本的患者显示,可预防的ED (43.3%) 和住院患者 (13.5%) 的支出比例相似.
结论:
- 在高成本的医疗保险患者中,医疗保健成本的有限比例是由于可预防的急救诊所和住院治疗.
- 在这个队列中,通过加强门诊护理来降低成本的潜力可能受到限制.
- 区域初级保健医生供应与高成本患者的更高可预防支出相关.
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