使用健康计划质量措施指数解决医疗保健差距问题。

IF 2.1 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
American Journal of Managed Care Pub Date : 2025-09-01 Epub Date: 2025-02-26 DOI:10.37765/ajmc.2025.89701
Joseph A Stankaitis, Samyukta Singh, Sean Nicholson
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引用次数: 0

摘要

目标:利用可公开获得的数据编制一个指数,以衡量在解决卫生保健差距方面取得的进展。研究设计:考虑到商业/私人保险投保人和医疗补助投保人之间固有的社会经济差异,我们根据设定的标准,选择了一组指标,比较医疗保健有效性数据和信息集(HEDIS)中这两条产品线的全国平均表现。方法:使用国家质量保证委员会公开报告的来自商业/私人保险和医疗补助管理医疗的HEDIS质量指标的全国平均水平的数据,将观察到的这些措施的差异汇总起来建立指数。结果:健康保险差异指数(HeIDI)显示,从2017年到2022年,全国商业/私人保险个人与医疗补助保险个人之间的差距逐渐恶化,在COVID-19大流行期间和之后大幅恶化。结论:由于HeIDI通过保险项目评估影响社会经济地位较低个体的医疗保健差距状况,因此它有助于利用经过验证的HEDIS数据评估健康计划、州、地区和卫生系统的绩效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Addressing health care disparities using a health plan quality measures index.

Objectives: To develop an index using publicly available data to measure progress in addressing health care disparities.

Study design: Given inherent socioeconomic differences between individuals insured by commercial/private insurance and those insured by Medicaid, we selected, based on set criteria, a portfolio of metrics comparing the national average performance between these 2 product lines from the Healthcare Effectiveness Data and Information Set (HEDIS).

Methods: Using data from the National Committee for Quality Assurance publicly reported national averages for HEDIS quality metrics from commercial/private insurance and Medicaid managed care, observed differences for these measures were aggregated to establish the index.

Results: The Health Insurance Disparities Index (HeIDI) demonstrated a gradual worsening of disparities nationally between individuals with commercial/private insurance and individuals with Medicaid insurance from 2017 to 2022, with a substantial deterioration during and after the COVID-19 pandemic years.

Conclusions: Because HeIDI assesses the status of health care disparities impacting individuals of lower socioeconomic status by insurance lines, it is useful for assessing performance for health plans, states, regions, and health systems utilizing verified HEDIS data.

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来源期刊
American Journal of Managed Care
American Journal of Managed Care 医学-卫生保健
CiteScore
3.60
自引率
0.00%
发文量
177
审稿时长
4-8 weeks
期刊介绍: The American Journal of Managed Care is an independent, peer-reviewed publication dedicated to disseminating clinical information to managed care physicians, clinical decision makers, and other healthcare professionals. Its aim is to stimulate scientific communication in the ever-evolving field of managed care. The American Journal of Managed Care addresses a broad range of issues relevant to clinical decision making in a cost-constrained environment and examines the impact of clinical, management, and policy interventions and programs on healthcare and economic outcomes.
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