在传统医疗保险中家庭独立的流行 - 合格的受益者,2014-2021年
Tom Lally1, Emily Johnson1, Konstantinos E Deligiannidis2
1Bloom Health, Denver, Colorado.
JAMA network open
|July 11, 2024
概括
传统医疗保险 (TM) 的高需求受益人数显著增长,占支出的更大份额. 医疗保险优势 (MA) 也招收这些人,强调了需要价值为基础的项目,如在家独立 (IAH).
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
- 老年医学 老年医学
背景情况:
- 在家中独立 (IAH) 演示测试了基于价值的模型中的家庭初级保健,在十年的医疗保险节省后得出结论.
- 高需要的受益人对传统医疗保险 (TM) 构成重大挑战.
- 医疗保险优势 (MA) 可能为管理高需求人群提供程序优势.
研究的目的:
- 评估在TM和MA内的IAH合格受益人的增长和分布.
- 为了比较高需要的受益者在TM的入学趋势与MA.
主要方法:
- 一项队列研究分析了2014年和2021年的Medicare索赔和MA遭遇数据.
- 将IAH资格标准应用于TM和MA群体.
- 计算了IAH合格受益人的增长,并比较了他们在TM和MA中的比例.
主要成果:
- 在2014年至2021年期间,在TM中IAH合格受益人数增加了51% (2.16M至3.27M),从6.4%增长到TM入学率的10.7%.
- 这些受益者在2021年TM支出中占1550亿美元 (44%),高于2014年的29%.
- 2021年,有215万名IAH合格受益者在MA (8.0%的MA入学者),其中60.3%的IAH合格受益者 (3.27M) 在TM.
结论:
- 在TM中,IAH资格受益者的比例显著增加,其中60%的需要高的人在TM支出中占44%.
- 以价值为基础的计划,如在家独立,对于有效管理高需要的医疗保险受益者至关重要.
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