在医疗补助患者中,程序性处方拒绝和急性护理利用和支出风险
Bhairavi Muralidharan1, Sanjay Basu1,2,3, Jeffrey Tingen1
1Clinical Product Development, Waymark, San Francisco, California.
JAMA network open
|January 30, 2025
概括
对于医疗补助患者来说,程序性处方拒绝增加了急性护理的使用和成本,超过了最初的药物储蓄. 卫生计划应该重新考虑覆盖政策,以避免这些意外后果.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健服务研究 医疗服务研究
- 药物经济学 药物经济学
背景情况:
- 医疗补助计划下的处方药费用上导致医疗计划的处方拒绝程序增加.
- 未解决的处方拒绝对慢性疾病恶化和随后的急性护理利用的影响尚未得到充分理解.
研究的目的:
- 调查程序性处方拒绝与通过下游急性护理利用的净支出增加之间的联系,这些患者在拒绝后没有获得处方药的医疗补助计划患者中.
主要方法:
- 这项横截面研究利用了来自两个州和两个健康计划的2022-2023年的医疗补助索赔数据.
- 拒绝处方的患者与没有拒绝的患者根据人口统计,健康计划细节,慢性疾病和医疗保健利用情况进行了匹配.
- 在药物填充或拒绝后的60天内,急性护理的利用率和支出被比较.
主要成果:
- 处方被拒绝的患者面临着更高的相关急诊室访问和住院的风险 (调整后的几率比率范围:1.40-1.75).
- 六种药物类别的拒绝与增加的净医疗总支出有关,每年每个成员的额外费用从624美元到3016美元不等.
- 这些费用包括处方和医疗费用,归因于拒绝.
结论:
- 程序性处方拒绝,虽然旨在降低即时药物成本,但可能导致急性护理利用率和整体成本增加.
- 医疗计划在制定处方保险政策时应考虑这些意外后果.
- 建议在所有药物类别和计划中进行进一步的国家研究.
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