医疗保险服务费用与医疗保险优势受益人之间心血管手术使用的地理差异
Daniel D Matlock1, Peter W Groeneveld, Steve Sidney
1Division of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA. daniel.matlock@ucdenver.edu
JAMA
|July 11, 2013
概括
与医疗保险费用服务 (FFS) 患者相比,Medicare Advantage受益人的血管造影和皮肤冠状动脉干预 (PCI) 率较低,但在两种支付模式中,程序使用的地理差异很大,并且在两种支付模式中都相似.
科学领域:
- 心血管医学 心血管医学
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
背景情况:
- 医疗保险优势 (MA) 和医疗保险服务费 (FFS) 的报销结构不同,可能会影响心血管程序的利用.
- 了解这些差异对于公平的医疗保健和资源分配至关重要.
研究的目的:
- 为了比较MA和Medicare FFS受益人之间的区域心血管手术率.
- 调查金融激励对心血管程序使用的影响.
主要方法:
- 一项横截面研究分析了2003-2007年65岁以上的医疗保险受益者.
- 在12个州的32个医院转诊区域中,冠状动脉血管学,皮肤冠状动脉干预 (PCI) 和冠状动脉旁路移植 (CABG) 手术的发生率进行了比较.
- 数据包括878,339名MA患者和5,013,650名Medicare FFS患者.
主要成果:
- 与FFS受益者相比,MA受益者对血管造影 (16.5 vs 25.9 / 1000人年) 和PCI (6.8 vs 9.8 / 1000人年) 的年龄,性别,种族和收入调整率较低 (P < .001).
- 在MA和FFS受益者之间,CABG手术的发生率与MA和FFS受益者之间相似 (3.1对3.4每1000人年;P = .33).
- 在MA和FFS群体中观察到手术率的显著地理差异,MA和FFS在血管学,PCI或CABG的不同地区的利用之间没有强烈的相关性.
结论:
- 尽管与FFS相比,MA的血管造影和PCI率较低,但在两种医疗保险计划中,手术率存在实质性和相似的地理差异.
- 这些发现突显出,无论医疗保险支付模式如何,在心血管保健提供方面存在显著的区域差异.
- 需要进一步的研究来了解这些地理差异的驱动因素及其临床影响.
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