在医疗保险优势计划中注册的退伍军人中,手术护理的支付来源转移
Winta T Mehtsun1, Yanlei Ma2, Ellen Latsko2
1Department of Surgery, University of California, San Diego.
JAMA health forum
|June 9, 2025
概括
医疗保险优势计划不成比例地招募退伍军人,导致费用转移到退伍军人卫生管理局进行手术护理. 高退伍军人MA计划显示,MA支付的手术较少,VHA支付的护理更多.
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
- 退伍军人事务 医疗保健 医疗保健
背景情况:
- 人们越来越担心医疗保险优势 (MA) 计划将护理费用转移到退伍军人卫生管理局 (VHA) 对双重注册退伍军人.
- 据怀疑,高退伍军人MA计划,与不成比例的退伍军人入学,加剧了这种成本转移现象.
- 关于不同类型的退伍军人计划中退伍军人手术护理支付来源的实证证据是有限的.
研究的目的:
- 评估高资深MA计划与其他MA计划之间手术护理支付来源的差异.
- 量化退伍军人手术服务从MA转向VHA的潜在成本转移的程度.
主要方法:
- 一项横截面研究分析了2021年美国国家MA和VHA数据,用于接受住院手术的双重注册退伍军人.
- 支付来源分为VHA直接护理,VHA支付社区护理和MA支付社区护理.
- 多项逻辑回归评估了高退伍军人MA计划 (≥20%的退伍军人) 和外科手术支付来源之间的入学关系,并调整了共变量和状态固定效应.
主要成果:
- 分析包括54,754例住院外科手术发作.
- 与其他MA计划的退伍军人相比,高退伍军人MA计划的退伍军人接受MA支付手术的可能性明显低 (调整后的差异为-25.7个百分点),并且获得VHA支付护理的可能性更高 (VHA直接:+11.0个百分点;VHA社区:+14.7个百分点).
- 随着手术复杂度的增加,以及通过急诊室进行非选择性手术的支付差异缩小.
结论:
- 调查结果表明,在高退伍军人MA计划中注册的退伍军人中,外科护理的成本从MA转移到VHA.
- 这凸显了政策改革的必要性,以确保为双重入伍的退伍军人提供公平有效的护理.
- 该研究强调了MA计划构成对VHA系统的财务影响.
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