Medical Care最新文献

{"title":"Differences in Initiation and Receipt of Home Health Care: Traditional Medicare Versus Medicare Advantage.","authors":"Amanda C Chen, Daniel Spertus, Christina X Fu, Madeline R Sterling, David C Grabowski","doi":"10.1097/MLR.0000000000002150","DOIUrl":"10.1097/MLR.0000000000002150","url":null,"abstract":"<p><strong>Background: </strong>Because Traditional Medicare (TM) and Medicare Advantage (MA) have different reimbursement structures and incentives, it is important to understand differences in home health agency (HHA) use by payer type.</p><p><strong>Objective: </strong>To quantify differences in care patterns and outcomes between TM and MA HHA users.</p><p><strong>Research design and subjects: </strong>Medicare HHA claims were used to identify postacute HHA episodes among US adults aged 65 and older enrolled in MA or TM (2015-2019). Adjusted regression models with and without HHA fixed effects assessed whether TM and MA beneficiaries are treated differently within an HHA.</p><p><strong>Measures: </strong>We examined process (timely initiation of care, receipt of a skilled nursing visit, and length of stay) and quality measures (hospital readmission and healthy days at home).</p><p><strong>Results: </strong>The study included 4,029,527 beneficiaries (3,034,452 TM and 995,075 MA). We identified large differences in the share of beneficiaries experiencing timely initiation of care (81.4% TM vs. 77.4% MA) and receipt of skilled nursing visits (86.8% TM vs. 81.9% MA). After including HHA fixed effects in the regression model, MA beneficiaries were 2.1 percentage points (pp) less likely to experience timely initiation of care and were 3.1 pp less likely to receive a skilled nursing visit (and 8.9 pp less likely to receive any type of skilled visit) within 2 days of starting HHA care compared with TM beneficiaries ( P <0.001).</p><p><strong>Conclusions: </strong>Our findings suggest differential treatment between MA and TM beneficiaries within the same HHA. Further research is needed to understand the mechanisms driving these within-agency differences.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"487-494"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Primary Care Spending in the United States: Toward a Common Method.","authors":"Chunliu Zhan, Lingrui Liu, Matthew Simpson","doi":"10.1097/MLR.0000000000002155","DOIUrl":"10.1097/MLR.0000000000002155","url":null,"abstract":"<p><strong>Background: </strong>The lack of common definition and methods, coupled with the scarcity of suitable data sources, have impeded efforts to track primary care spending in the United States.</p><p><strong>Objectives: </strong>Explore consistent approaches to estimating primary care spending.</p><p><strong>Research design: </strong>A recently developed framework for primary care services was applied to 2 datasets: the Medical Expenditure Panel Survey (MEPS), a survey of noninstitutionalized individuals and their families in the United States, and MarketScan, a database containing health insurance claims of employees and their dependents for a selection of major US companies, to estimate primary care spending per-person-per-year (PPPY) and as percentage of total health care spending (PTHS) covering 2010-2021. Cross-sectional and trend analyses were conducted, and key methodological issues were explored.</p><p><strong>Results: </strong>In 2019, average primary care spending was $504 PPPY (95% CI: $469-$539), accounting for 8.07% PTHS (95% CI: 7.56%-8.58%), based on MEPS, and $378 PPPY (95% CI: $377-$379), accounting for 6.30% PTHS (95% CI: 6.28%-6.32%), based on MarketScan. There were steady increases between 2010 and 2021 in PPPY primary care spending (from $309 to $639 based on MEPS and from $343 to $433 based on MarketScan), but small fluctuations in PHTS primary care spending (between 6% and 9%). Misalignments between the definitions and the data were identified, and standard errors for the estimates were calculated.</p><p><strong>Conclusions: </strong>With explicit definitions, transparent methodologies and appropriate quantification of estimation uncertainty, comparable and reproducible estimates can be obtained to assess and track primary care spending in the United States.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"514-519"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Pharmacy Copayment Increase on Medication Use in the Military Health System.","authors":"Ira B Wilson, Roee Gutman, Yoojin Lee, Beth A Dana, Jeff Hiris, Tingting Zhang, Kathryn Thompson, Richard Gromadzki, Theresa I Shireman","doi":"10.1097/MLR.0000000000002176","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002176","url":null,"abstract":"<p><strong>Background: </strong>We analyzed the impact of a copayment increase instituted February 1, 2018 for persons covered by the retail or mail order Military Health System (MHS) pharmacy benefit.</p><p><strong>Methods: </strong>We compared medication use in 2 cohorts in the 12 months before and after the copayment increase: MHS beneficiaries between 18 and 64 years old (MHS cohort), and MHS beneficiaries older than or equal to 65 years old with Medicare (Medicare cohort). Subjects with diabetes, hypertension and hypercholesterolemia were eligible. Using propensity score matching, we compared the control group of those who obtained medications at military pharmacies ($0 copay) to those who experienced a copay increase. The outcome variable was any use of condition-specific medication.</p><p><strong>Results: </strong>In the MHS cohort there were 30,753, 46,965, and 59,783 non-unique persons with diabetes, hyperlipidemia, and hypertension, respectively, in the intervention and control groups. In the Medicare cohort there were 45,977, 205,363, and 365,628 non-unique persons, respectively. The post-period mPDC differences for the MHS cohort were 0.02 (95% CI: 0.01, 0.03), 0.03 (95% CI: 0.02, 0.03), and 0.03 (95% CI: 0.01, 0.03) for the diabetes, hyperlipidemia, and hypertension cohorts, respectively. The post-period mPDC differences for the Medicare cohort were 0.01 (95% CI: 0.01, 0.02), 0.03 (95% CI: 0.03, 0.04), and 0.01 (95% CI: 0.01, 0.02), respectively.</p><p><strong>Conclusions: </strong>The small (1-3 percentage point) copayment increases are unlikely to have had adverse clinical effects. Insurers and policy-makers should understand that even small copayment increases can impact the use of clinically important medications and should carefully consider the tradeoffs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Threads of Care: Unraveling the Impact of Agency Nursing Staff on Nursing Home Quality.","authors":"Rohit Pradhan, Akbar Ghiasi, Ganisher Davlyatov, Shivani Gupta, Robert Weech-Maldonado","doi":"10.1097/MLR.0000000000002114","DOIUrl":"10.1097/MLR.0000000000002114","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association of agency nursing staff utilization with nursing home (NH) quality.</p><p><strong>Background: </strong>Nursing staff are the primary caregivers in NHs, where high-quality care is contingent upon their adequacy and expertise. Long-standing staffing challenges, exacerbated by the COVID-19 pandemic, have led NHs to rely on agency/contract labor to alleviate staffing shortages.</p><p><strong>Methods: </strong>This study used the following secondary datasets: Payroll-Based Journal, Care Compare: 5-Star Quality Rating System, LTCFocus.org, Area Health Resource Files, and Rural-Urban Commuting Area codes for 2017-2022. Multivariable ordinal logistic regression with 2-way (facility and year-level) fixed effects was employed. The study included all Centers for Medicare and Medicaid Services certified U.S. NHs. Analytic data comprised 80,244 facilities, averaging 13,374 unique NHs per year. The study focused on the quality star rating (1-5 scale) from the 5-Star Quality Rating System as the dependent variable. Independent variables included the proportion of agency nursing staff hours per resident day for registered nurses, licensed practical nurses, and certified nursing assistants while controlling for facility and community characteristics that may affect NH quality.</p><p><strong>Results: </strong>A 10% increase in agency registered nurses, licensed practical nurses, and certified nursing assistants (logged) was associated with a decrease in the odds of achieving a higher star rating by 4%, 5%, and 4%, respectively ( P < 0.001).</p><p><strong>Conclusions: </strong>The use of agency nursing staff can negatively impact NH quality. Efforts to better integrate agency nursing staff into NHs, combined with strategies to recruit and retain permanent nursing staff, could lead to improved outcomes for residents.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"479-486"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Sleep Is Not Getting the Attention It Deserves\": A Qualitative Study of Patient and Provider Views on Sleep Management in the Veterans Health Administration.","authors":"Allison E Gaffey, Kristin M Mattocks, Henry K Yaggi, Valerie Marteeny, Lorrie Walker, Cynthia A Brandt, Sally G Haskell, Lori A Bastian, Matthew M Burg","doi":"10.1097/MLR.0000000000002152","DOIUrl":"10.1097/MLR.0000000000002152","url":null,"abstract":"<p><strong>Background: </strong>Unique characteristics and service exposures of the post-9/11 cohort of U.S. Veterans can influence their sleep health and associated comorbidities. The objectives of this study were to learn about men and women post-9/11 Veterans' and \"front line\" VA providers' knowledge about sleep and experiences with Veterans Health Administration (VA) sleep management.</p><p><strong>Research design: </strong>One sample included post-9/11 Veterans who received VA care (n=23; 60% women; Mage: 45 y). To complement those views, primary care and mental health providers were recruited from VA medical centers (n=27). Semistructured qualitative interviews were conducted using Microsoft Teams. Questions pertained to sleep knowledge, care practices, and perceived barriers to sleep-related VA care. Interview data were synthesized with content analysis and inductive coding to characterize major themes.</p><p><strong>Results: </strong>Four main themes emerged: (1) Sleep is viewed as foundational but Veterans and providers often have limited related knowledge and more routine education is needed. (2) Men and women have distinct sleep management needs. Relative to men, women are more likely to advocate for sleep assessment and for behavioral versus pharmacological treatment. (3) Sleep management practices vary considerably between clinics and providers. (4) Veterans and their providers each experience unique barriers to sleep management.</p><p><strong>Conclusions: </strong>Post-9/11 Veterans and providers view sleep as critical. Yet, VA sleep management needs to be more uniform. Providers are motivated to assess sleep but require standardized education and low-burden opportunities to incorporate sleep into their practice, perhaps with mental health screening. Ultimately, more specialized care is required to meet the responsibility of Veterans' sleep health.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"472-478"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Complications and Readmission Rates in Robotic-Assisted and Manual Total Hip Arthroplasty: A Large, Multi-Hospital Study.","authors":"Cole Howell, Sietske Witvoet, Laura Scholl, Andrea Coppolecchia, Manoshi Bhowmik-Stoker, Antonia F Chen","doi":"10.1097/MLR.0000000000002082","DOIUrl":"10.1097/MLR.0000000000002082","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to compare 90-day postoperative complications, readmissions, and emergency department (ED) visits between robotic-assisted (RA-THA) and manual (M-THA) total hip arthroplasty.</p><p><strong>Methods: </strong>A retrospective review of a multi-hospital database identified primary total hip arthroplasty patients between January 2016 and December 2021. The cohorts were 1-to-1 matched based on patient sex, age, and body mass index resulting in 8033 patients in each cohort (N = 16,066). Odds of 90-day revisits, readmission with >23 hours of observation, and ED visits were compared between cohorts. Complications reported during revisits and readmission were classified according to the Clinical Classification Software schema, using the International Classification of Diseases, 10th Revision codes, and compared using mixed-effect models.</p><p><strong>Results: </strong>This study found an overall 90-day revisit rate of 8.3%. RA-THA was associated with significantly reduced odds of revisit within 90 days [odds ratio (OR): 0.71, 95% CI: 0.58-0.89, P = 0.002] and readmissions with >23 hours of observation (OR: 0.61, 95% CI: 0.48-0.77, P < 0.001). RA-THA patients had fewer readmissions with >23 hours of observation due to dislocations (RA-THA: 0.09%; M-THA: 0.39%, P < 0.001), surgical site infections (RA-THA: 0.04%; M-THA: 0.20%, P = 0.004), and wound infections/cellulitis (RA-THA: 0.01%; M-THA: 0.11%, P = 0.021). No difference in ED visits was observed between cohorts (OR: 0.92, 95% CI: 0.77-1.09, P = 0.3). RA-THA patients had more ED visits for dyspnea without pulmonary embolism (RA-THA: 0.20%; M-THA: 0.06%, P = 0.03).</p><p><strong>Conclusion: </strong>RA-THA showed significantly lower odds of overall 90-day revisit rates and readmissions with >23 hours of observation, most notably for readmissions due to dislocation and surgical site infection/wound infections. There was no significant difference in the odds of ED visits between cohorts.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 7","pages":"465-471"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Medical Care Cost by Service Type Associated With Lung Cancer Screening.","authors":"Kris Wain, Mahesh Maiyani, Nikki M Carroll, Rafael Meza, Robert T Greenlee, Christine Neslund-Dudas, Michelle R Odelberg, Caryn Oshiro, Debra P Ritzwoller","doi":"10.1097/MLR.0000000000002169","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002169","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer screening (LCS) enhances early stage cancer detection; however, its impact on health care costs in real-world clinical settings is not well understood. The objective of this study was to assess changes in health care costs during the 12 months before LCS compared with the 12 months after.</p><p><strong>Methods: </strong>This retrospective study analyzed health care costs based upon Medicare's fee-for-service reimbursement system using data from the Population-based Research to Optimize the Screening Process Lung Consortium. We included individuals who met age and smoking LCS eligibility criteria and were engaged within 4 health care systems between February 5, 2015, and December 31, 2021. Generalized linear models estimated health care costs from the payer perspective during 12 months prior and 12 months post baseline LCS. We compared these costs to eligible individuals who did not receive LCS. Secondary analyses examined costs among the sample who completed LCS by positive versus negative scan results. We reported mean predicted costs with average values for all other explanatory variables.</p><p><strong>Results: </strong>We identified 10,049 eligible individuals who received baseline LCS and 15,233 who did not receive LCS. Receipt of LCS was associated with additional costs of $3698 compared with individuals not receiving LCS. Secondary analyses found costs increased by $11,664 among individuals with positive scans; however, no increases occurred among individuals with negative scans.</p><p><strong>Conclusion: </strong>These findings suggest LCS was only associated with increased health care costs among patients with a positive scan. LCS is a potentially cost-effective approach to identify early stage lung cancer. Healthcare systems should prioritize strategies to improve LCS participation.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a Better Understanding of Primary Care Physician Career Typologies.","authors":"Erin Fraher, Todd Jensen, Alberta Tran, Evan Galloway, Jasmine Weiss, Brianna Lombardi","doi":"10.1097/MLR.0000000000002167","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002167","url":null,"abstract":"<p><strong>Background: </strong>The nation faces a persistent shortage and maldistribution of primary care physicians (PCPs). A better understanding of PCP career typologies could help policy makers target interventions toward certain subgroups, rather than using a \"one-size fits all\" approach to improving PCP supply, distribution and diversity across settings and in rural areas.</p><p><strong>Methods: </strong>This study used cross-sectional data from 2009 and 2019, derived from the North Carolina (NC) Medical Board, on PCPs in active practice in family medicine, general internal medicine, general pediatrics, geriatrics, and obstetrics and gynecology in NC. We used latent class analysis (LCA) to investigate: (1) whether different career typologies exist in the primary care physician workforce; (2) if so, whether career typologies changed in the 10-year period before the COVID-19 pandemic (2009 and 2019); and (3) whether a physician's generational cohort, age, sex, race/ethnicity, career stage, and medical school location were associated with different career typologies.</p><p><strong>Results: </strong>The LCA yielded 4 distinct career typologies in both 2009 and 2019 with high levels of class separation. The 4 typologies were relatively stable over the decade. Distinguishing factors between typologies included practice in a rural area, hospital, and ambulatory care employment, and provision of obstetric and prenatal care.</p><p><strong>Conclusions: </strong>Understanding PCP career typologies could be used to tailor interventions to improve the supply and distribution of PCP workforce. Medical schools could use this information to support trainees' decision-making about future careers and policy makers to target funding for training to support careers in rural and ambulatory settings.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Top-Rated Health Care and Ease of Access to Medications Linked to Lower Medicare and ADRD Costs.","authors":"Jie Chen, Seyeon Jang","doi":"10.1097/MLR.0000000000002140","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002140","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about the extent to which patient self-perception of care experience is associated with costs, especially for people with Alzheimer disease and related dementias (ADRD).</p><p><strong>Objective: </strong>This study explores the relationship between self-reported quality measures and Medicare costs and examines whether the ease of obtaining prescribed medications is associated with reduced overall Medicare costs, focusing on Medicare beneficiaries with ADRD.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, Medicare Beneficiary Summary File data from 2018, 2019, and 2021 were linked to the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey using beneficiary IDs. The study sample included community-dwelling Medicare fee-for-service beneficiaries.</p><p><strong>Exposures: </strong>Five quality measures were used as key exposure variables: (1) beneficiary's rating on health care; (2) ease of getting care/tests/treatment through the health plan; (3) whether the doctor always explained, listened, respected; and spent enough time with the patient; (4) ease of obtaining prescribed medications; and (5) whether doctor always talked about all the prescription medicines the beneficiary was taking.</p><p><strong>Main outcome and measure: </strong>Annual total Medicare payments per person.</p><p><strong>Results: </strong>The study included 230,617 Medicare fee-for-service beneficiaries aged 65 and older, including 16,452 beneficiaries with ADRD. Among the total beneficiaries, 53% were females (vs. 56% of ADRD beneficiaries), with a mean (SD) age of 75.8 (SD 7.27) years [vs. 82.5 (SD 7.97) years for ADRD beneficiaries]. Fully adjusted analyses showed significant negative associations between quality measures and total per-capita payments, with more pronounced cost reductions among patients with ADRD. Specifically, patients with ADRD who reported it was always easy to get care had reductions of $1,922.0 (95% CI, -$3304.8 to -$539.2), while those who reported it was always easy to get prescribed medications had reductions of $2964.5 (95% CI, -$4518.8 to -$1410.1). In addition, beneficiaries who reported that doctors always discussed the medicines experienced cost reductions of $2299.7 (95% CI, -$3800.5 to -$799.0) in medicare costs.</p><p><strong>Conclusion and relevance: </strong>Our findings suggest that high-quality care is not necessarily associated with high costs. Meanwhile, focusing on the ease of access to needed care, obtaining prescription drugs, and effective communication about medication is critical in improving care quality while reducing costs.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 6","pages":"405-412"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Adjustment in Capitation Payments to Primary Care Providers: Does It Matter How We Account for Patients' Socioeconomic Status?","authors":"Lina Maria Ellegård, Maude Laberge","doi":"10.1097/MLR.0000000000002141","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002141","url":null,"abstract":"<p><strong>Background: </strong>One of the critical challenges with capitation payment to primary care providers is ensuring that the fixed payments are equitable and adjusted for expected care needs. Patients of lower socioeconomic status (SES) generally have higher health care need. Sweden developed a Care Needs Index, which is used in the capitation payments to primary care providers to account for patient SES.</p><p><strong>Objectives: </strong>We aim to examine the potential value of collecting individual-level rather than geographic-level socioeconomic data to support an equitable payment to primary care providers.</p><p><strong>Research design: </strong>We used data from 3 regional administrative care registers, which cover all consultations in publicly funded health care, and Statistics Sweden's registers covering individual background characteristics. We estimated linear regression models and evaluated the model fit using the adjusted R2 with the Care Needs Index at the individual and at the district level. The population consisted of the 3,490,943 individuals residing in the 3 study regions for whom we had complete data.</p><p><strong>Measures: </strong>The main outcome variable was the number of face-to-face consultations with a GP or a nurse at a primary care practice. We use the R2 to compare the predictive power of the models.</p><p><strong>Results: </strong>The share of the variation explained did not depend on whether the Care Needs Index was measured at the individual level or the small area level.</p><p><strong>Conclusions: </strong>SES explains very little variation in primary care visits, and there is no gain from having individual-level information about the individual's SES compared with having district-level information only.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 6","pages":"430-435"},"PeriodicalIF":3.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}