使用传统医疗保险和医疗保险优势索赔数据检查家庭健康的方法方法
Jianhui Xu1, Jamie M Smith2, Julia G Burgdorf3
1Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Health services research
|February 5, 2026
概括
一种新方法使用医疗保险索赔来跟踪家庭健康停留,表明它在患者驱动分组模型之前和之后对传统医疗保险和医疗保险优势计划都起作用. 这使得可以进行直接的利用比较.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保险政策 医疗保险政策
- 首页 医疗保健 分析
背景情况:
- 传统医疗保险 (TM) 和医疗保险优势 (MA) 有不同的数据来源用于家庭健康利用.
- 需要标准化的方法来比较不同医疗保险人群的医疗保健利用率.
- 患者驱动分组模型 (PDGM) 影响了家庭医疗支付和服务交付.
研究的目的:
- 开发和验证基于索赔的方法来识别新的家庭医疗停留.
- 为了能够直接比较TM和MA受益者之间的家庭健康利用情况.
- 在PDGM实施之前和之后评估方法的可行性.
主要方法:
- 使用的传统医疗保险 (TM) 索赔和医疗保险优势 (MA) 遇到的数据来自2019年和2021年.
- 使用索赔数据构建了一种方法来识别新的家庭健康停留.
- 分析了一次或多次停留的受益人百分比和平均停留时间 (LOS).
主要成果:
- 2019年,与MA (5.9%) 相比,TM的受益者比例略高,有新的家庭医疗停留 (6.5%).
- 大约90%的家庭医疗接受者在TM和MA都有单次住宿.
- 2019年TM的平均LOS为44天,MA为39天,在2021年TM的平均LOS增加到46天.
结论:
- 基于索赔的方法在TM和MA中构建新的家庭健康停留是可行的.
- 该方法在PDGM实施前和之后都可靠地执行.
- 这种方法有助于在TM和MA人群中直接比较家庭健康利用率.
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