与按服务收费的参保人相比,享受医疗保险优惠的参保人入院的结果是更好还是更差?

Bernard Friedman, H Joanna Jiang
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引用次数: 10

摘要

医疗保险受益人选择的医院可能取决于患者是否参加了医疗保险优势(MA)计划。MA计划利润最大化的理论模型考虑了消费者对年保费的偏好与医院护理结果和计划的其他属性之间的权衡。由保健研究和质量局维护的2006年13个州的出院数据库是数据的主要来源。在大约1 500家医院的15种临床类别中,所有非产妇成年患者的风险调整死亡率均可获得。对900家医院的手术病例计算了涵盖9类事件的全成人术后安全事件率。工具变量用于解决MA计划选择的潜在内生性问题。主要发现如下:与按服务收费(FFS)的参保人相比,MA计划的参保人倾向于在资源成本较低、风险调整死亡率较高的医院接受治疗。MA计划参保者的风险调整死亡率比总体平均的4%高出约1.5个百分点。然而,手术患者的安全事件发生率倾向于MA计划参保者,比平均3.5%的发生率低1个百分点。这些差异的结果值得注意,而且似乎是由于健康计划在批准患者进行选择性手术以及为手术患者选择医院方面具有更大的自由裁量权。急诊患者通常被排除在安全结果措施之外。此外,目前的死亡率测量可能不能充分代表所有手术患者。在提供比较数据时,应突出强调这些警告。有了这一附带条件,该研究证明向医疗保险受益人通报MA计划使用的医院与FFS参保人使用的医院的死亡率和安全结果措施是合理的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees?

The hospitals selected by or for Medicare beneficiaries might depend on whether the patient is enrolled in a Medicare Advantage (MA) plan. A theoretical model of profit maximization by MA plans takes into account the tradeoffs of consumer preferences for annual premium versus outcomes of care in the hospital and other attributes of the plan. Hospital discharge databases for 13 states in 2006, maintained by the Agency for Healthcare Research and Quality, are the main source of data. Risk-adjusted mortality rates are available for all non-maternity adult patients in each of 15 clinical categories in about 1,500 hospitals. All-adult postoperative safety event rates covering 9 categories of events are calculated for surgical cases in about 900 hospitals. Instrumental variables are used to address potential endogeneity of the choice of a MA plan. The key findings are these: enrollees in MA plans tend to be treated in hospitals with lower resource cost and higher risk-adjusted mortality compared to Fee-for-Service (FFS) enrollees. The risk-adjusted mortality measure is about 1.5 percentage points higher for MA plan enrollees than the overall mean of 4%. However, the rate of safety events in surgical patients favors MA plan enrollees--the rate is 1 percentage point below the average of 3.5%. These discrepant results are noteworthy and are plausibly due to greater discretion by the health plan in approving patients for elective surgery and as well as selecting hospitals for surgical patients. Emergency patients are generally excluded for the safety outcome measures. In addition, the current mortality measures may not adequately represent all surgical patients. Such caveats should be prominently highlighted when presenting comparative data. With that proviso, the study justifies informing Medicare beneficiaries about the mortality and safety outcome measures for hospitals being used by a MA plan compared to hospitals used by FFS enrollees.

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