科罗拉多州的合作医疗费用分摊和转诊率。

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
ACS Applied Electronic Materials Pub Date : 2024-09-01 Epub Date: 2024-07-03 DOI:10.1097/MLR.0000000000002033
Betsy Q Cliff, Tiffany H Xie, Neda Laiteerapong
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引用次数: 0

摘要

背景:协作医疗将心理健康治疗融入到初级保健中,并已被证明行之有效。然而,即使是在鼓励使用协作式医疗的州,使用率仍然很低,并且存在潜在的医疗财务障碍:研究设计:研究设计:使用行政医疗索赔数据进行回顾性观察研究,以确定协同护理的门诊就诊情况。对于就诊次数≥1 次的个人,我们以月为单位衡量支出和就诊次数。在开具合作护理账单的医生中,我们测量了符合条件的患者使用合作护理的普遍程度:2018-2019年科罗拉多州的医疗保险、医疗保险优势或商业医疗保险患者:自付费用(参保人向临床医生支付的费用)、总支出(保险公司+参保人向临床医生支付的费用)、开具合作医疗账单的患者百分比:总支出(保险公司+患者费用)中位数为 48.32 美元(IQR:41-53 美元)。合作医疗每月自付费用中位数为每次就诊 8.35 美元(IQR:0-10 美元)。商业保险患者每月支付的费用最高(中位数:15 美元);医疗保险优势患者支付的费用最低(中位数:0 美元)。在开具合作护理账单的临床医生(人数=193)中,平均有 12% 的合格患者使用了合作护理;家庭医生和高级临床医生的患者最常使用合作护理:结论:协作医疗的使用率仍然偏低,每 6 名符合条件的患者中只有不到 1 人接受了协作医疗。自付费用各不相同,但普遍较低;费用的不确定性可能是导致使用率低的原因之一。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Collaborative Care Cost-Sharing and Referral Rates in Colorado.

Background: Collaborative care integrates mental health treatment into primary care and has been shown effective. Yet even in states where its use has been encouraged, take-up remains low and there are potential financial barriers to care.

Objective: Describe patient out-of-pocket costs and variations in referral patterns for collaborative care in Colorado.

Research design: Retrospective observational study using administrative medical claims data to identify outpatient visits with collaborative care. For individuals with ≥1 visit, we measure spending and visits at the month level. Among physicians with billings for collaborative care, we measure prevalence of eligible patients with collaborative care utilization.

Subjects: Patients with Medicare, Medicare Advantage, or commercial health insurance in Colorado, 2018-2019.

Outcomes: Out-of-pocket costs (enrollee payments to clinicians), total spending (insurer+enrollee payments to clinicians), percent of patients billed collaborative care.

Results: Median total spending (insurer+patient cost) was $48.32 (IQR: $41-$53). Median out-of-pocket cost per month in collaborative care was $8.35 per visit (IQR: $0-$10). Patients with commercial insurance paid the most per month (median: $15); patients with Medicare Advantage paid the least (median: $0). Among clinicians billing for collaborative care (n=193), a mean of 12 percent of eligible patients utilized collaborative care; family practice and advanced practice clinicians' patients utilized it most often.

Conclusions: Collaborative care remains underused with fewer than 1 in 6 potentially eligible patients receiving care in this setting. Out-of-pocket costs varied, though were generally low; uncertainty about costs may contribute to low uptake.

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CiteScore
7.20
自引率
4.30%
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