在医疗保险优势和传统医疗保险中延长住院时间
Brian E McGarry1, Andrew D Wilcock2, Ashvin D Gandhi3
1Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York.
JAMA internal medicine
|September 8, 2025
概括
医疗保险优势患者在2017-2023年期间比传统的医疗保险患者在医院住院时间更长. 这些长时间住院,特别是那些被送往熟练护理机构的人,导致数百万额外的医院住院.
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
- 老年医学 老年医学
背景情况:
- 医院在及时释放患者方面面临越来越多的挑战,通常是由于急性后护理限制.
- 医疗保险优势计划现在是医疗保险覆盖的主要形式.
- 医疗保险优势计划内的潜在的行政和网络限制可能导致退院延误,但国家数据有限.
研究的目的:
- 量化和比较医疗保险优势 (MA) 和传统医疗保险 (TM) 受益人之间住院时间 (LOS) 的变化.
- 调查MA覆盖对医院出院效率的影响.
主要方法:
- 追溯队列研究利用2017年至2023年第三季度的医疗保险索赔数据.
- 包括美国急症护理和重症进入医院的短期住院患者入院.
- 调整为患者人口统计和医院固定效应的差异回归模型.
主要成果:
- 对于MA入院的平均LOS从6.0日增加到7.1天,而TM则从5.8日增加到6.3天.
- 与TM相比,MA入院患者在长期住院的可能性显著高 (≥14,≥21,≥28天).
- 在2022年,MA患者的长期住院占据了估计180万额外的医院病床日.
结论:
- 医疗保险优惠计划的受益人从2017年到2023年间,医院LOS的增加不成比例.
- 与保险相关的出院障碍可能导致医院病床日数增加,特别是对于从熟练护理机构出院的患者.
- 解决这些障碍对于改善医院吞吐量和患者结果至关重要,因为MA招生人数不断增长.
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