医疗保险家庭健康服务：护理总疗程描述

Branch L G, Goldberg H B, Cheh V A, Williams J

Abt Associates, Cambridge, MA 02138.

Health Care Financ Rev. 1993 Summer;14(4):59-74.

The purpose of this study was to present descriptive information on the characteristics of 2,873 Medicare home health clients, to quantify systematically their patterns of service utilization and allowed charges during a total episode of care, and to clarify the bivariate associations between client characteristics and utilization. The model client was female, 75-84 years of age, living with a spouse, and frail based on a variety of indicators. The mean total episode was approximately 23 visits, with allowed charges of $1,238 (1986 dollars). Specific subgroups of clients, defined by their morbidities and frailties, used identifiable clusters of services. Implications for case-mix models and implications for capitation payments under health care reform are discussed.

本研究的目的是提供关于2873名医疗保险居家健康客户特征的描述性信息，系统量化他们在整个护理期间的服务使用模式和允许费用，并阐明客户特征与服务使用之间的双变量关联。典型客户为女性，年龄在75至84岁之间，与配偶同住，且根据各种指标判断身体虚弱。平均整个护理期间约为23次访视，允许费用为1238美元（1986年美元价值）。根据其发病率和身体虚弱程度定义的特定客户亚组使用了可识别的服务类别。文中还讨论了对病例组合模型的影响以及医疗保健改革下人头付费的影响。