Taylor Donald H, Hoenig Helen
Duke University Center for Health Policy, Terry Sanford Institute of Public Policy, 302 Towerview Road, Box 90253, Durham, NC 27708, USA.
Health Serv Res. 2006 Jun;41(3 Pt 1):743-58. doi: 10.1111/j.1475-6773.2006.00509.x.
To determine whether difficulty walking and the strategies persons use to compensate for this deficit influenced downstream Medicare expenditures.
Secondary data analysis of Medicare claims data (1999-2000) for age-eligible Medicare beneficiaries (N=4,997) responding to the community portion of the 1999 National Long Term Care Survey (NLTCS).
Longitudinal cohort study. Walking difficulty and compensatory strategy were measured at the 1999 NLTCS, and used to predict health care use as measured in Medicare claims data from the survey date through year-end 2000.
Respondents to the 1999 community NLTCS with complete information on key explanatory variables (walking difficulty and compensatory strategy) were linked with Medicare claims to define outcome variables (health care use and cost).
Persons who reported it was very difficult to walk had more downstream home health visits (1.1/month, p<.001), but fewer outpatient physician visits (-0.16/month, p<.001) after controlling for overall disease burden. Those using a compensatory strategy for walking also had increased home health visits/month (0.55 for equipment, 1.0 for personal assistance, p<.001 for both) but did not have significantly reduced outpatient visits. Persons reporting difficulty walking had increased downstream Medicare costs ranging from 163 US dollars to 222 US dollars/month (p<.001) depending upon how difficult walking was. Less than half of the persons who used equipment to adapt to walking difficulty had their difficulty fully compensated by the use of equipment. Persons using equipment that fully compensated their difficulty used around 300 US dollars/month less in Medicare-financed costs compared with those with residual difficulty.
Difficulty walking and use of compensatory strategies are correlated with the use of Medicare-financed services. The potential impact on the Medicare program is large, given how common such limitations are among the elderly.
确定行走困难以及人们用于弥补这一缺陷的策略是否会影响医疗保险的下游支出。
对符合年龄条件的医疗保险受益人群（N = 4997）的医疗保险索赔数据（1999 - 2000年）进行二次数据分析，这些人群回应了1999年全国长期护理调查（NLTCS）的社区部分。
纵向队列研究。在1999年NLTCS中测量行走困难和补偿策略，并用于预测从调查日期到2000年底医疗保险索赔数据中所衡量的医疗保健使用情况。
1999年社区NLTCS的受访者若具备关键解释变量（行走困难和补偿策略）的完整信息，则与医疗保险索赔相关联，以定义结果变量（医疗保健使用和成本）。
在控制总体疾病负担后，报告行走非常困难的人有更多的下游家庭健康访视（1.1次/月，p <.001），但门诊医生访视较少（-0.16次/月，p <.001）。采用行走补偿策略的人每月的家庭健康访视次数也有所增加（使用设备的为0.55次，使用个人协助的为1.0次，两者p <.001），但门诊访视次数没有显著减少。报告行走困难的人下游医疗保险成本增加，每月增加163美元至222美元不等（p <.001），具体取决于行走困难程度。使用设备来适应行走困难的人中，不到一半的人的困难通过使用设备得到了完全补偿。与仍有残余困难的人相比，使用设备完全补偿了困难的人每月在医疗保险资助成本上少用约300美元。
行走困难和补偿策略的使用与医疗保险资助服务的使用相关。鉴于此类限制在老年人中非常普遍，对医疗保险计划的潜在影响很大。
