选择加入还是选择退出? 在俄俄州,双重资格受益人的金融调整背后的选择
Athena Koumoutzis1, Jennifer Heston-Mullins1, Heather R Reece1
1Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA.
Journal of aging & social policy
|July 15, 2025
概括
许多符合医疗保险和医疗补助计划的受益人选择退出金融调整计划 (FAI). 这限制了协调护理的准入,并阻碍了FAI的发展.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 医疗保健管理的管理
背景情况:
- 金融调整倡议 (FAI) 旨在改善对符合Medicare和Medicaid资格的受益人的护理协调.
- 受益人选择退出FAI的医疗保险部分,这对其有效性构成了潜在的挑战.
- 了解选择/选择退出模式对于评估此类演示至关重要.
研究的目的:
- 检查俄俄州FAI示威的选择或选择退出的程度和影响.
- 确定与退出相关的人口和服务相关因素.
- 探讨由于受益者选择退出,护理经理和提供者面临的挑战.
主要方法:
- 对俄俄州医疗补助局数据的分析 (2021年11月).
- 采访36个提供长期服务和支持或急症护理的组织的定性数据.
- 关于不同年龄组和服务设置中选择退出率的描述性统计.
主要成果:
- 42%的双重资格受益人选择不参加俄俄州的FAI演示.
- 在长期停留护理机构居民 (51%) 和年轻年龄组中观察到更高的选择退出率.
- 选择退出导致报告的挑战,包括缺乏护理准入,沟通不良以及在护理过渡期间的困难.
结论:
- 受益人选择退出FAI,这给协调护理带来了重大障碍,特别是对于那些患有复杂疾病的人来说.
- 这些障碍限制了该倡议在提高护理质量和成本效益方面的成功.
- 对于未来的演示,需要制定改善参与度和解决选择退出原因的策略.
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