医疗保险管理计划退出与护理质量之间的关联,2006年至2014年
Chima D Ndumele1, William L Schpero1, Mark J Schlesinger1
1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
JAMA
|June 28, 2017
概括
在2006年至2014年期间,医疗保险的退出是常见的. 退出计划的质量较低,但退出计划并没有显著改变整体市场质量或患者体验.
科学领域:
- 医疗服务研究
- 公共卫生政策
- 管理护理质量
背景情况:
- 国家医疗补助计划越来越多地利用管理护理计划.
- 保险公司退出这些计划可能会影响护理质量和患者体验.
- 了解退出计划的动态对于医疗补助计划的稳定性至关重要.
研究的目的:
- 确定医疗保险计划退出医疗保险的频率和地理差异.
- 评估健康计划退出与市场水平质量指标之间的关系.
主要方法:
- 对390个Medicaid综合管理护理计划 (2006-2014) 的回顾性队列研究.
- 退出计划的分析定义为退出州的医疗补助计划.
- 通过医疗保健有效性数据和信息集 (HEDIS) 和通过医疗保健提供者和系统消费者评估 (CAHPS) 调查的患者体验来评估质量.
主要成果:
- 在2006年至2014年期间,366个计划中有106个退出医疗补助计划,影响了超过480万受益者.
- 退出计划表明预防和产妇护理质量明显降低,以及退出前的患者体验.
- 计划退出与整体市场质量或患者体验的重大变化无关.
结论:
- 在2006年至2014年期间,美国医疗补助计划的退出频繁.
- 退出医疗补助计划的标准通常低于剩余计划.
- 退出并没有导致医疗补助市场的质量或患者体验显著下降.
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