Porell F W, Miltiades H B
Gerontology Institute, University of Massachusetts Boston, 02125, USA.
J Am Geriatr Soc. 2001 May;49(5):615-31. doi: 10.1046/j.1532-5415.2001.49123.x.
To investigate whether older Medicare beneficiaries enrolled in Medicare risk health maintenance organizations (HMOs) have different rates of disablement than fee-for-service (FFS) beneficiaries.
Secondary analysis of annual functional status transitions using the Medicare Current Beneficiary Survey, 1991 to 1996.
Telephone interviews.
Forty-four thousand seven hundred and sixty-five person-years of annual functional status transitions for noninstitutionalized older Medicare beneficiaries who were either risk HMO enrollees or FFS beneficiaries with or without private supplementary insurance.
Five multinomial logit models were estimated as single-state transition models, with five functional states, death, and censored as outcomes. The probability of being in a certain functional state the following year was specified as a function of individual risk factors and HMO versus FFS supplementary insurance status.
Among functionally independent beneficiaries, the odds of becoming disabled in activities of daily living (ADLs) within a year were lower among FFS individuals with supplementary insurance (odds ratios (OR) = 0.67, P <.01) and HMO enrollees (OR = 0.58, P <.01). Among older people who were functionally impaired, neither HMO enrollment nor private supplementary insurance affected the risk of further functional decline or functional improvement. Supplementary insurance, but not HMO enrollment, was associated with lower mortality risk among beneficiaries with functional limitations (OR = 0.65, P <.05) or moderate ADL disability (OR = 0.72, P <.05).
Medicare risk HMO enrollment and FFS private supplementary insurance convey similar benefits of slowing functional decline and extending life span for nonseverely disabled older people. That no association was found between adverse functional status outcomes and risk HMO enrollment has favorable implications regarding the quality of care of managed care plans.
调查参加医疗保险风险健康维护组织（HMO）的老年医疗保险受益人是否比按服务收费（FFS）的受益人有不同的残疾率。
使用1991年至1996年医疗保险当前受益人调查对年度功能状态转变进行二次分析。
电话访谈。
44765人年的年度功能状态转变，涉及未入住机构的老年医疗保险受益人，他们要么是HMO风险参保者，要么是有或没有私人补充保险的FFS受益人。
估计了五个多项logit模型作为单状态转变模型，以五个功能状态、死亡和删失作为结果。将次年处于特定功能状态的概率指定为个体风险因素以及HMO与FFS补充保险状态的函数。
在功能独立的受益人中，有补充保险的FFS个体（优势比（OR）=0.67，P<.01）和HMO参保者（OR = 0.58，P<.01）在一年内日常生活活动（ADL）中致残的几率较低。在功能受损的老年人中，参加HMO或私人补充保险均不影响进一步功能下降或功能改善的风险。补充保险而非参加HMO与功能受限受益人（OR = 0.65，P<.05）或中度ADL残疾受益人（OR = 0.72，P<.05）的较低死亡风险相关。
参加医疗保险风险HMO和FFS私人补充保险对于非严重残疾的老年人在减缓功能下降和延长寿命方面具有相似的益处。未发现不良功能状态结果与参加风险HMO之间存在关联，这对于管理式医疗计划的护理质量具有积极意义。
