强制性捆绑支付与社会经济差异变化之间的关联对于联合替换结果
Austin S Kilaru1,2,3, Joshua M Liao2,4, Erkuan Wang1,2,5
1The Parity Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
强制性捆绑支付下肢关节置换 (LEJR) 减少了双重资格的医疗保险受益人的并发症差异. 这项研究首次提供了基于价值的支付模式下减少社会经济差异的证据.
科学领域:
- 卫生经济学 卫生经济学
- 基于价值的医疗保健
- 健康中的社会经济差异.
背景情况:
- 捆绑支付模式旨在提高医疗保健质量和降低成本.
- 关节置换综合护理 (CJR) 计划要求医院参与下肢关节置换 (LEJR) 捆绑支付.
- 了解强制参与对弱势群体结果差异的影响至关重要.
研究的目的:
- 评估强制性医院参与LEJR捆绑支付和结果差异变化之间的关联.
- 为了比较双重资格 (医疗保险和医疗补助) 和非双重资格受益人之间的LEJR并发症,再录取和死亡率的变化.
- 评估综合关节置换护理 (CJR) 计划对社会经济差异的影响.
主要方法:
- 使用医疗保险索赔数据 (2011-2017) 的回顾性观察性研究.
- 差异差异分析比较双重资格和非双重资格的受益人.
- 干预组:CJR参与医院的患者;比较组:符合条件但不参与医院的患者.
主要成果:
- 总共有1,603,555名受益人被纳入;11.0%是双重资格的.
- 强制性CJR参与与双重资格和非双重资格受益人之间的LEJR并发症差异的减少有关 (-0.9个百分点).
- 没有观察到90天再入院或死亡率的显著差异变化.
结论:
- 强制参与捆绑支付计划可以减少手术结果的社会经济差异.
- 该CJR计划在减少低收入医疗保险受益人的并发症差异方面产生了积极影响.
- 这项研究提供了第一个证据,证明在基于价值的支付计划下,公平性改善了结果.
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