在风险调整变化后,痴呆症诊断增加了与传统医疗保险相比的医疗保险优势
Sidra Haye1, Mireille Jacobson2, Geoffrey Joyce3
1Sidra Haye, University of Southern California, Los Angeles, California.
Health affairs (Project Hope)
|January 6, 2025
概括
与传统医疗保险相比,Medicare Advantage计划中对痴呆症诊断的财政激励增加了11.5%的诊断率. 这种增长在高风险人群中最为显著,这引发了关于过度诊断的问题.
科学领域:
- 卫生经济学 卫生经济学
- 老年医学 老年医学
- 公共卫生政策 公共卫生政策
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 在2020年重新将阿尔茨海默病和相关痴呆症引入医疗保险优势 (MA) 风险调整模型.
- 风险调整对于基于入学者的健康状况向MA计划支付公平的费用至关重要.
研究的目的:
- 评估将痴呆症重新引入CMS风险调整模型对事件痴呆症诊断率的影响.
- 为了比较MA受益人与传统医疗保险受益人的诊断率变化.
主要方法:
- 对所有社区居住的医疗保险受益人的2017-2020年数据的分析.
- 在MA和传统医疗保险注册者之间对痴呆症诊断率的比较评估.
- 对特定的人口和社会经济小组的诊断增加的评估.
主要成果:
- 在MA计划中,每年发病痴呆症诊断率相对于恢复后的传统医疗保险增加了11.5%.
- 这种增加不成比例地观察到可能患有未诊断的痴呆症的受益人 (西班牙裔/黑人,85岁以上,双重资格或低收入补贴受益人).
- 图表审查只占诊断的观察增加的三分之一.
结论:
- 在MA风险调整模型中的财务激励措施明显增加了痴呆症诊断.
- 增加集中在脆弱人群中,这表明检测有所改善,但也引起了人们对潜在的过度诊断或升级编码的担忧.
- 需要进一步的研究来验证这些增加的诊断的准确性,并解决潜在的金融操纵.
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