Gardner E N, Murtaugh C M, Ray N F, Thamer M
Johns Hopkins University School of Hygiene and Public Health Services Research and Development Center, Baltimore, MD 21205-1901, USA.
Am J Manag Care. 1999 Nov;5(11):1417-25.
To estimate the mean annual per capita cost of care provided to disabled adult Medicaid recipients with neurologic conditions and to compare mean annual costs for disabled adult Medicaid recipients with those of nondisabled adult Medicaid recipients.
Medicaid eligibility and claims files for all of calendar year 1993 were obtained from the state of Pennsylvania. Mean annual per capita costs are mean Medicaid expenditures on claims filed for Medicaid-covered services and pharmaceuticals provided in 1993 to full-year eligible Medicaid recipients.
Disabled adults aged 18 to 64 years with one or more of several neurologic conditions were identified from medical diagnoses (International Classification of Diseases, 9th Revision codes) reported on claims. A comparison group of nondisabled adults was chosen from the Medicaid Eligibility File. Annual costs were estimated for a wide range of specific services as well as for 3 broad service categories.
There were large differences between disabled and nondisabled adults in mean annual per capita costs of acute care and other medical services ($4142 vs $1451), rehabilitation and support services ($3835 vs $235), and pharmaceuticals ($1116 vs $382). Mean costs also differed significantly among persons with different neurologic conditions. The mean annual per capita cost for all services was $5368 for adults with epilepsy and $19,356 for those with a spinal cord injury. All differences are statistically significant (P < .001).
States may want to separately capitate rehabilitation and support services given the large differences in the magnitude and relative distribution of costs for disabled and nondisabled Medicaid recipients.
估算为患有神经系统疾病的成年残疾医疗补助受助者提供护理的人均年均费用，并比较成年残疾医疗补助受助者与非残疾成年医疗补助受助者的年均费用。
获取了宾夕法尼亚州1993年全年的医疗补助资格和理赔档案。人均年均费用是指1993年为全年符合资格的医疗补助受助者就医疗补助涵盖的服务和药品提出理赔申请的医疗补助支出均值。
从理赔申请中报告的医学诊断（国际疾病分类第九版编码）中识别出年龄在18至64岁之间、患有几种神经系统疾病中一种或多种的成年残疾者。从医疗补助资格档案中选取一组非残疾成年者作为对照组。估算了各类特定服务以及三大类服务的年度费用。
残疾与非残疾成年人在急性护理和其他医疗服务的人均年均费用（4142美元对1451美元）、康复和支持服务（3835美元对235美元）以及药品（1116美元对382美元）方面存在巨大差异。不同神经系统疾病患者的平均费用也存在显著差异。癫痫成年患者的所有服务人均年均费用为5368美元，脊髓损伤患者为19356美元。所有差异均具有统计学意义（P < 0.001）。
鉴于残疾与非残疾医疗补助受助者在费用规模和相对分布上存在巨大差异，各州可能希望对康复和支持服务分别实行按人头付费。
