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Healthcare Agencies II01:17

Healthcare Agencies II

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There are various healthcare agencies in the United States—some of which are managed by religious institutions and others by different government branches.
Parish nursing is a growing specialty nursing profession that focuses on holistic healthcare, health promotion, and illness prevention. It blends professional nursing practice with a health ministry, focusing on health and healing within the context of a Christian community. Parish nurses serve as health educators, referral sources,...
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Hazard Ratio01:12

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The hazard ratio (HR) is a widely used measure in clinical trials to compare the risk of events, such as death or disease recurrence, between two groups over time. It reflects the ratio of hazard rates—the instantaneous risk of the event occurring—between a treatment group and a control group. This measure provides valuable insights into the relative effectiveness of a treatment by assessing how the risk of an event differs between the two groups.
For example, in a clinical trial...
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Healthcare Agencies I01:18

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Healthcare agencies provide healthcare services to people. In the United States, voluntary agencies are often non-profit centers sponsored by donations, grants, or fundraisers. One such organization is Meals on Wheels, which provides meals to the elderly and homebound. The American Heart Association and the American Lung Association are other non-profit community organizations. Doctors and nurses are frequently active members of these organizations, which offer health checks and educational...
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An integrated healthcare system (IHS) is a set of organizations that provides for or arranges to provide coordinated and continuous service to a defined population. The IHS takes responsibility for that particular population's health status and outcome, both clinically and fiscally. An integrated healthcare system is a well-organized, well-coordinated, and collaborative network. The integrated delivery system is a network that connects different healthcare providers to deliver organized,...
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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
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相关实验视频

Updated: May 10, 2025

Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
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通过交换器识别医疗保险优势中的编码强度.

Paul D Jacobs1, Timothy J Layton2

  • 1U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Division of Research and Modeling, Rockville, Maryland, USA.

Health services research
|April 28, 2025
PubMed
概括

与传统的医疗保险相比,医疗保险优势计划显示出更高的健康风险编码强度. 这种编码强度的差异随着时间的推移而增加,这表明Medicare Advantage注册人的潜在超支付.

关键词:
美国医疗保险 (Medicare) 的医疗保险.医疗保险优势是什么临床编码 临床编码管理竞争 管理竞争风险调整风险的调整.

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科学领域:

  • 卫生经济学 卫生经济学
  • 医疗服务研究 医疗服务研究
  • 医学编码分析分析

背景情况:

  • 传统医疗保险 (TM) 和医疗保险优惠 (MA) 有不同的支付结构.
  • 之前的研究表明,与TM相比,MA的诊断数量和严重程度更高.
  • 了解编码强度差异对于准确的医疗保险支付至关重要.

研究的目的:

  • 量化TM和MA之间的健康风险编码强度差异.
  • 分析转换到MA的受益人编码强度如何随着时间的推移而演变.
  • 提供根据编码强度调整MA支付的证据.

主要方法:

  • 对从TM转换到MA的受益人与留在TM的受益人的风险评分进行比较.
  • 使用了10%的医疗保险和医疗补助服务中心数据样本 (2012-2021).
  • 与医疗保险当前受益者调查相关的行政数据,以测量健康状况.

主要成果:

  • 转换MA的风险分数在第二年高出12.4%,第三年高出17.2%,第六年高出22.3%.
  • 总体而言,MA编码强度导致2021年与TM相比,MA编码强度的风险得分高出18.6%.
  • 编码强度随着时间的推移和不同的入学队伍而增加.

结论:

  • 该研究的编码强度估计在现有文献中处于较高的水平.
  • 调查结果解决了关于MA招生中内源性切换的担忧.
  • 结果可以为MA支付的政策调整提供信息,以考虑编码强度差异.