有一个VA优势吗? 双重资格退伍军人的证据
David C Chan1, David Card2, Lowell Taylor3
1Stanford University, Department of Veterans Affairs, and NBER.
概括
与私人医疗保险资助的医疗相比,美国退伍军人事务部 (VA) 的医疗保健系统显著降低了老年退伍军人的死亡率和医疗保健支出. 随着时间的推移,这些生存和成本效益的改善是持续的.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年医学 老年医学
- 公共卫生政策 公共卫生政策
背景情况:
- 年长的退伍军人 (65岁以上) 有资格通过美国退伍军人事务部 (VA) 或由医疗保险资助的私人医院获得护理.
- 了解这些不同的医疗保健系统的比较有效性和效率对于资源配置和患者的结果至关重要.
研究的目的:
- 为了比较VA医疗保健与Medicare资助的私人医疗对65岁及以上退伍军人的死亡率和支出的影响.
- 确定可能导致两个系统之间的结果和服务交付差异的潜在因素.
主要方法:
- 利用"救护车设计" (Doyle等人,2015年) 来分析医疗保健获得的准实验变化.
- 在接受VA护理的退伍军人和接受私人护理的退伍军人之间比较了28天的死亡率和医疗保健支出.
主要成果:
- VA系统与28天死亡率降低46% (4.5个百分点),存活率持续增加有关.
- 与私人护理相比,VA还显示28天的支出减少了21%.
- 在VA和私人医院之间报告的服务中观察到显著的差异.
结论:
- 与私人医疗保险资助的护理相比,VA医疗保健系统为老年退伍军人提供了显著的生存效益和成本节省.
- 有证据表明,VA系统内的护理连续性,健康信息技术 (IT) 和综合护理模式之间存在潜在的互补性.
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