在替代性医疗保险计划下获得的医疗保健服务的研究

Q4 Medicine

Journal of health and human services administration Pub Date : 2021-01-01 DOI:10.37808/jhhsa.44.4.4

Douglas Smith, S. Stout, M. Wieck

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引用次数: 0

摘要

对密苏里州100万医疗保险受益人的详细医疗记录的随机抽样分析显示，参加医疗保险优势组织健康维护计划(HMO计划)的个人的医疗服务使用率明显低于参加传统医疗保险按服务收费(FFS)计划的个人。当我们对被保险人的医疗状况和人口特征、他们所在县的医疗服务可获得性以及受益人的初级保健提供者的报销安排进行统计控制时，五个主要场所(医院住院、医院门诊、一般载体服务、家庭保健和熟练护理设施)的使用和服务组合的差异仍然存在。因此，医疗保险优惠计划登记人数的持续增长预计将对提供保健服务所需的资源和为老年人提供医疗服务的场所产生重大影响。

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A Study of Healthcare Services Received under Alternative Medicare Insurance Plans

An analysis of detailed medical encounter records for a random sample of one million Missouri Medicare beneficiaries reveals dramatically lower usage of medical services by individuals enrolled in Medicare Advantage Organization health maintenance programs (HMO plans) than by individuals enrolled in traditional Medicare fee-for-service (FFS) plans. Differences in usage and mix of services in five major venues (hospital inpatient, hospital outpatient, general carrier services, home health, and skilled nursing facilities) persist when we control statistically for medical condition and demographic characteristics of insured individuals, availability of medical services in the counties where they reside, and reimbursement arrangements for beneficiaries’ primary-care providers. Continuing growth in enrollment for Medicare Advantage plans is therefore expected to have a substantial impact on the resources required for delivery of healthcare services and upon the venues in which medical services for the elderly will be provided.

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来源期刊

Journal of health and human services administration Nursing-Leadership and Management

CiteScore

1.60

自引率

0.00%

发文量

期刊介绍： The Journal of Health and Human Services Administration (JHHSA) began publication in 1978 as the Journal of Health and Human Resources Administration. It is a blind-refereed journal dedicated to publishing articles, symposia and book reviews in all areas of health, hospital and welfare administration and management.