医疗保险优势计划的特点与将受益人分类到能够减少可避免住院时间的提供者有关
Jianhui Xu1, Kelly E Anderson2, Angela Liu1
1Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Health services research
|May 30, 2024
概括
医疗保险优势 (MA) 计划可以指导受益者找到提供者,其可避免的住院时间较少. 然而,这种影响因计划类型而异,健康维护组织 (HMO) 和高星级评级是关键因素.
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
- 老年学是一门学科.
背景情况:
- 医疗保险优势 (MA) 计划是传统医疗保险 (TM) 的越来越受欢迎的替代方案.
- 了解MA计划特征如何影响医疗保健利用,特别是可避免的住院治疗,对于优化患者的治疗结果和医疗保健支出至关重要.
研究的目的:
- 调查特定的Medicare Advantage计划特征与受益人转向与较少可避免住院时间相关的提供者之间的关联.
- 量化由MA计划设计驱动的患者分类对可避免的住院治疗的影响.
主要方法:
- 利用了2018-2019年医疗保险优势遭遇数据和传统的医疗保险索赔数据,用于20%的国家样本.
- 雇员调整的波桑回归,有或没有临床医生固定的效果,以分析可避免的住院时间,跨计划类型,运营商,星级和网络宽度.
- 计算了系数的差异,以评估患者分类对TM的影响程度.
主要成果:
- 观察到受计划设计影响的患者分类. 卫生维护组织 (HMO) 占这一效应的86%,而PPO占14%.
- 高明星合同 (94%) 和特定的运营商 (Humana和较小的运营商,89%) 是患者分类的重要贡献者.
- 狭窄的网络计划县解释了20%的患者分类效应.
结论:
- 医疗保险优势计划与将受益人指向提供者产生更少可避免的住院时间有关.
- 医疗保险计划对可避免的住院治疗的影响不均;健康维护组织 (HMO) 和高星级计划是这种现象的主要驱动因素.
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