医生与卫生系统之间的垂直关系中的利用,指导和支出
Anna D Sinaiko1, Vilsa E Curto1, Katherine Ianni2
1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA health forum
|September 1, 2023
概括
初级保健医生 (PCP) 和卫生系统之间的垂直关系增加了专家访问和医疗支出. 这项研究没有发现患者再入院的显著差异,这表明潜在的方向是进入卫生系统.
科学领域:
- 医疗保健经济学 医疗保健经济学
- 医疗保健服务研究 医疗服务研究
- 医生与系统的整合
背景情况:
- 在美国,医生与卫生系统之间的垂直关系,如所有权或附属关系,越来越普遍.
- 这些关系可能会影响医疗保健的提供,利用和成本.
研究的目的:
- 检查初级保健医生 (PCP) 与大型卫生系统之间的垂直关系之间的关联.
- 分析出行和急症护理利用情况的变化,转诊模式,再接收以及商业保险人员的总医疗支出.
主要方法:
- 采用了一项病例控制研究,采用重复的横截面,堆叠的事件设计.
- 该研究分析了马萨诸塞州2013-2017年商业保险人员的数据,比较了PCP进入垂直关系的患者与没有进入垂直关系的患者.
- 结果包括专家访问,急诊室 (ED) 访问,住院和每年患者的总医疗支出.
主要成果:
- 垂直关系与每年病人的专家诊所数量显著增加有关 (+0.69次, +22.64%).
- 总体医疗开支也增加了356.67美元每年患者 (+6.26%).
- 在PCP的医疗系统中,观察到医疗专家访问,急救访问和住院住院的使用率增加,再入院率没有显著差异.
结论:
- PCP与卫生系统之间的垂直整合与患者护理支出和利用率的增加有关,包括在系统内指导患者.
- 尽管支出和利用增加,但垂直关系并没有对患者再入院率产生影响.
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