非正式照顾对美国退伍军人卫生管理局利用和支出的影响
Josephine C Jacobs1, Jeanie Lo2, Courtney H Van Houtven3
1Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park CA, USA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.
成年儿童的非正式照顾显著减少了美国退伍军人的医疗保健使用和成本. 这一发现支持护理人员支持计划,显示了退伍军人事务卫生系统的成本节省.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年学是一门学科.
- 卫生经济学 卫生经济学
背景情况:
- 有限的研究存在于非正式护理对医疗保健利用和支出的影响,特别是在美国退伍军人.
- 美国退伍军人事务部 (VA) 正在增加对护理人员支持的投资,需要了解非正式护理的经济影响.
- 非正式和正式护理之间的内生关系需要在利用和支出分析中仔细考虑.
研究的目的:
- 检查从成年儿童获得非正式照顾对美国退伍军人的医疗保健利用和支出的影响.
- 在分析中考虑非正式和正式护理之间的潜在内源性.
- 通过量化非正式护理的成本和收益,为VA的护理人员支持政策提供信息.
主要方法:
- 利用了一个独特的数据集,将健康和退休研究 (1998-2010) 与VA行政数据联系起来.
- 包括2083名退伍军人与9511人波观测.
- 应用了仪器变量技术来解决内源性,并估计非正式护理对VA利用和支出在两年的影响.
主要成果:
- 非正式的护理收入使VA的整体利用率下降了53个百分点,支出减少了19,977.7美元.
- 在住院患者 (17个百分点),门诊患者 (57个百分点) 和机构长期护理 (3个百分点) 中观察到使用率的减少.
- 非机构长期护理的支出也减少了882美元,医疗复杂的患者节省了最大的费用.
结论:
- 非正式护理显著减少了美国退伍军人的医疗保健利用和支出,特别是那些有复杂医疗需求的人.
- 调查结果表明,VA的护理人员津贴支付与非正式护理替代产生的成本节约之间存在一致性.
- 考虑护理人员支持计划的卫生系统可能会发现,非正式护理会抵消正式护理成本,特别是在需要高的人群中.
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