下肢关节置换的捆绑支付计划与医疗保险优势受益人中的患者结果之间的关联
Amanda Sutherland1, Emily Boudreau1, Andy Bowe1
1Humana Inc, Louisville, Kentucky.
JAMA health forum
|June 25, 2023
概括
下肢关节置换手术 (LEJR) 的捆绑支付减少了2.7%的病例支出,但没有影响质量结果. 这个医疗保险优势计划展示了一个有效的替代支付模式,以收费为服务,降低成本,同时保持患者护理标准.
科学领域:
- 卫生经济学 卫生经济学
- 以价值为基础的护理
- 整形外科手术的结果
背景情况:
- 捆绑支付的证据主要来自传统的医疗保险.
- 私人保险公司,包括医疗保险优势计划,越来越多地采用捆绑支付模式.
- 这些私人保险公司计划对诸如下肢关节置换手术 (LEJR) 等手术的支出和质量的影响仍未得到充分研究.
研究的目的:
- 评估国家医疗保险优势保险公司提供的自愿捆绑支付计划与LEJR手术事件支出和护理质量的变化之间的关联.
- 确定这种私人保险公司模式是否会影响医疗保健成本和患者的治疗结果.
主要方法:
- 一项横截面研究分析了23,034个LEJR手术情节,模拟了一个阶梯设计.
- 该研究利用了从2012年1月到2019年9月分阶段推出的捆绑支付计划.
- 情节级回归模型比较了参与计划前后的变化,使用非参与实践作为控制.
主要成果:
- 参与捆绑支付计划与节目支出下降2.7%有关.
- 观察到熟练护理设施的使用减少 (OR,0.81) 和门诊外科手术设置的使用增加 (OR,1.79).
- 在90天并发症率 (OR,1.02) 或再入院率 (OR,0.92) 中没有发现显著变化.
结论:
- 医生实践参与这个LEJR捆绑支付计划减少了节目支出而不会影响质量.
- 医疗保险优势计划提供的捆绑支付提供了一个可行的替代支付模式,而不是服务费.
- 这些发现表明,捆绑支付有可能降低LEJR病例的成本,同时保持护理质量.
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