与医疗保险储蓄相关的初级保健连续性,频率和规律性
Dilara Sonmez1, George Weyer2, Daniel Adelman1
1University of Chicago Booth School of Business, Chicago, Illinois.
JAMA network open
|August 21, 2023
概括
定期和频繁的初级保健访问与显著的医疗保险节省有关. 优化访问模式,包括规律性和连续性,可以最大限度地节省这些费用,并提高急性护理的利用率.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 主要护理医学 医疗保健
背景情况:
- 减少医疗保险支出是一个优先事项,以价值为基础的护理模式强调初级保健.
- 最佳组织初级保健访问以最大限度地节省医疗保险并未得到充分理解.
研究的目的:
- 调查初级保健访问模式和医疗保险储蓄之间的关系.
- 确定访问频率,规律性和连续性如何影响医疗保健支出和利用率.
主要方法:
- 使用5%的传统医疗保险索赔 (2016-2019) 样本进行了回顾性队列研究.
- 包括至少有3次初级保健访问的受益者和第一次和最后一次访问之间的180天,不包括医疗保险优惠计划的入学者,末期脏病患者或住院人士.
- 分析了访问频率,规律性,连续性,医疗保险支出,急诊室访问和住院住院的数据.
主要成果:
- 定期和高度连续的初级保健访问与最大的医疗保险节省 (175.87%) 有关.
- 这些模式还与风险调整支出减少 (-16.61%),急诊室访问 (-40.49%) 和住院 (-53.32%) 相相关.
- 随着访问频率的增加,特别是复杂患者的访问频率,节省成本的增加,并且这种关联与减少规律性和连续性相反.
结论:
- 初级保健访问频率,规律性和连续性是影响医疗保险节省和急性护理利用的相互关联的因素.
- 优化这些访问模式为改善Medicare基于价值的护理转型中的结果和降低成本提供了巨大的潜力.
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