在医疗保险中支付预先护理计划的费用:对临终护理和支出的影响

IF 3.4 2区 经济学 Q1 ECONOMICS
Alice J. Chen , Jing Li
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引用次数: 0

摘要

在美国,生命末期(EOL)的支出占医疗支出的比例很大,而且还在不断增长,这往往反映出积极的护理对垂死病人的价值值得怀疑。我们使用一种新颖的工具变量方法,首次研究了医疗保险对预先护理计划(ACP)的补偿的因果效应,预先护理计划是指讨论和记录患者对护理目标的偏好的过程,它对医疗保险重症患者的护理利用率、支出和死亡率结果都有影响。我们发现,开具账单的 ACP 服务在一年内大幅增加了临终关怀的使用率和临终关怀的支出,同时一年的死亡率也相应增加。ACP 服务对临终关怀使用和支出的影响在痴呆症患者和社会经济地位较低的患者中尤为突出。在死者中,在医院死亡的可能性明显降低,生命最后 30 天内的总支出和住院费用也显著下降。我们的研究结果表明,为 ACP 服务付费可以有效改善医疗保险重症患者的安宁疗护使用情况,其结果(可能是预期的)是增加了一年的死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paying for advance care planning in medicare: Impacts on care and spending near end of life

Spending at end of life (EOL) accounts for a large and growing share of healthcare expenditures in the US, and often reflects aggressive care with questionable value for dying patients. Using a novel instrumental variables approach, we conduct the first study on the causal effect of Medicare reimbursement for advance care planning (ACP)—the process of discussing and recording patient preferences for goals of care—on care utilization, spending, and mortality outcomes for critically ill Medicare patients. We find that billed ACP services substantially increase hospice use and hospice spending within a year, accompanied by corresponding increase in one-year mortality. The impacts of ACP services on hospice use and spending are especially prominent among patients with dementia and those of lower socioeconomic status. Among decedents, death is significantly less likely to occur in the hospital, and total and inpatient spending within the last 30 days of life fall significantly. Our findings suggest that paying for ACP services can be effective in improving hospice use for critically ill Medicare patients, with the (possibly intended) consequence of increased one-year mortality.

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来源期刊
Journal of Health Economics
Journal of Health Economics 医学-卫生保健
CiteScore
6.10
自引率
2.90%
发文量
96
审稿时长
49 days
期刊介绍: This journal seeks articles related to the economics of health and medical care. Its scope will include the following topics: Production and supply of health services; Demand and utilization of health services; Financing of health services; Determinants of health, including investments in health and risky health behaviors; Economic consequences of ill-health; Behavioral models of demanders, suppliers and other health care agencies; Evaluation of policy interventions that yield economic insights; Efficiency and distributional aspects of health policy; and such other topics as the Editors may deem appropriate.
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