Gutterman E M, Markowitz J S, Lewis B, Fillit H
Consumer Health Sciences, Princeton, New Jersey 08540, USA.
J Am Geriatr Soc. 1999 Sep;47(9):1065-71. doi: 10.1111/j.1532-5415.1999.tb05228.x.
Managed care organizations (MCOs) will have increased responsibility for the care of large numbers of persons with dementia. There are, however, few studies that inform about decisions of healthcare utilization and expenditures for individuals with dementia in managed care.
To examine in a large MCO whether people diagnosed with dementia have higher healthcare utilization and costs than enrollees without dementia.
A retrospective study of medical and prescription claims.
An MCO covering more than 80,000 Medicare enrollees in four geographical locales between January 1, 1996, and March 31, 1998.
There were 677 paired cases with and without dementia. Controls were selected randomly and matched to cases on age, gender, and region.
Summed total costs and number of claims accrued during the study period, as well as a breakdown of costs and claims with respect to place of service, were annualized and adjusted for age, gender, and comorbid conditions. Costs and claims were broken down by place of service.
Dementia prevalence was 0.83%. Mean total costs were 1.5 times higher for patients with dementia relative to controls ($13,487 vs $9,276, P < .001) when annualized and adjusted for level of comorbidity. Almost 75% of the higher costs among cases were linked to inpatient expenses.
Higher costs for individuals with dementia and disproportionate inpatient costs in this MCO parallel patterns among Medicare enrollees in fee-for-service. The high prevalence of dementia among the oldest old coupled with the high costs of dementia care create very significant clinical and financial incentives for managed care plans to improve the care of members suffering from dementia.
管理式医疗组织（MCOs）对大量痴呆患者的护理责任将会增加。然而，关于管理式医疗中痴呆患者医疗服务利用和支出决策的研究却很少。
在一个大型MCO中，研究被诊断为痴呆的患者与无痴呆参保者相比，是否有更高的医疗服务利用率和成本。
对医疗和处方索赔进行回顾性研究。
一个MCO，在1996年1月1日至1998年3月31日期间，覆盖四个地理区域的80,000多名医疗保险参保者。
有677对有痴呆和无痴呆的病例。对照组是随机选择的，并在年龄、性别和地区方面与病例进行匹配。
研究期间累计的总成本和索赔数量，以及按服务地点分类的成本和索赔明细，进行年化处理，并根据年龄、性别和合并症进行调整。成本和索赔按服务地点分类。
痴呆患病率为0.83%。在按合并症水平进行年化和调整后，痴呆患者的平均总成本相对于对照组高出1.5倍（13,487美元对9,276美元，P < .001）。病例中近75%的较高成本与住院费用有关。
在这个MCO中，痴呆患者的成本较高，且住院成本不成比例，这与按服务收费的医疗保险参保者中的模式相似。最年长者中痴呆的高患病率以及痴呆护理的高成本，为管理式医疗计划改善痴呆患者的护理创造了非常重要的临床和财务激励措施。
