在非分配的医疗保险受益者中,在转移到更大ACO参与率的地区后,支出变化
Yucheng Hou1, Marisa Elena Domino2, Valerie A Lewis3
1Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston.
JAMA network open
|February 20, 2025
概括
负责任的护理组织 (ACO) 可以将医疗保险支出从门诊机构转移到非归属受益人的医生服务. 这表明,在ACO参与率较高的地区,人们正在朝着更便宜的门诊护理迈进.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 医疗保险政策 医疗保险政策
背景情况:
- 负责任的护理组织 (ACO) 旨在提高医疗保险护理效率和质量.
- ACOs对未被归因的医疗保险受益人的医疗保健支出的影响在很大程度上是未知的.
- 了解这些溢出效应对于评估ACO计划有效性至关重要.
研究的目的:
- 为了估计医疗保险受益人中医疗保健支出变化,不归因于ACOs.
- 分析支出变化,以应对在地理区域增加的ACO市场透率.
- 确定ACO是否影响更广泛的医疗保险人口的医疗保健利用模式.
主要方法:
- 一个重复的横截面研究,使用20%的医疗保险索赔样本 (2009-2017年).
- 分析包括65-99岁的受益者,他们在医院服务区 (HSA) 之间搬家,以及一个不搬家的对照组.
- 住院,门诊,医生服务和急诊的支出被标准化,并根据ACO透率进行比较.
主要成果:
- 迁移到ACO透率较高的地区与门诊设施支出下降5.8%相关.
- 在ACO透率较高的地区,医生服务支出增加了1.6%.
- 在总的急性住院和急性护理支出中观察到的变化很小.
结论:
- 这项研究提供了证据,表明市场层面的ACO溢出影响影响了非ACO分配的医疗保险受益人.
- 虽然急性护理总支出的变化有限,但门诊和医生支出的转变表明,人们正在向更便宜的护理环境迈进.
- 这些发现表明,在有较大ACO存在的市场内,门诊护理的效率可能会提高.
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