综合护理计划中双重资格的医疗保险和医疗补助受益人之间的质量,支出,利用和结果:系统审查
Eric T Roberts1,2, Ciara Duggan3, Rebekah Stein3
1University of Pennsylvania Perelman School of Medicine, Philadelphia.
JAMA health forum
|July 19, 2024
概括
综合护理计划 (ICP) 在减少双重符合条件的医疗保险-医疗补助受益人住院期间方面表现有前途. 然而,关于总体支出,质量和结果的证据仍然是混合的,需要进一步的研究.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
- 老年学是一门学科.
背景情况:
- 双重资格的医疗保险-医疗补助受益人经常通过分开的保险计划来导航分散的护理.
- 政策制定者越来越关注综合护理计划 (ICPs),以管理医疗保险和医疗补助福利和支出.
- 了解ICP对医疗保健支出,质量,利用率和患者结果的影响对于这一群体至关重要.
研究的目的:
- 系统地审查有关综合护理计划 (ICPs) 与医疗保健支出,质量,利用率和患者结果之间的相关性现有证据.
- 评估不同ICP模型的有效性,包括全包养老计划 (PACE),医疗保险-医疗补助计划 (MMP) 和完全集成的双重符合条件的特殊需求计划 (FIDE-SNP).
主要方法:
- 从2010年1月到2023年10月和11月,在PubMed/MEDLINE和谷歌学者中进行了全面的文献搜索.
- 来自美国联邦和州政府网站的报告也被包括在内,以扩大搜索.
- 包括的研究比较了ICP与Medicare和Medicaid双重资格的受益人的非综合安排,评估了至少100名受益人.
主要成果:
- 有证据表明,ICPs,特别是PACE和FIDE-SNPs,与减少长期养老院入院有关.
- 在一些MMP和FIDE-SNP评估中观察到门诊利用率的增加,尽管结果各不相同.
- 医疗保险-医疗补助计划 (MMP) 主要与更高的医疗保险支出有关,而有关医疗补助支出和护理协调的证据有限或不确.
结论:
- 这一系统性审查突出了双重资格受益人之间的综合护理计划 (ICPs) 证据基础的变化和重大差距.
- 虽然一些ICP显示出减少养老院使用的潜力,但对整体支出,特别是MMP的医疗保险支出仍然存在担忧.
- 进一步的研究是必要的,以解决证据差距,并为政策决策提供信息,旨在优化针对这一弱势群体的综合护理模式.
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