Fonkych Kateryna, O'Leary June F, Melnick Glenn A, Keeler Emmett B
RAND Health Pro gram, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA.
Am J Manag Care. 2008 Aug;14(8):505-12.
To estimate the effect of independent practice association (IPA) model HMOs and the Kaiser Foundation Health Plan's group model on inpatient utilization of Medicare beneficiaries in the last 2 years of life, compared with traditional fee-for-service (FFS) coverage.
Data from the Centers for Medicare & Medicaid Services were linked to inpatient discharge data from the California Office of Statewide Health Planning and Development for 1991-2001. A sample of aged Medicare beneficiaries who died between January 1998 and June 2001 and were continuously enrolled during the 2 years before death in (1) FFS (n = 234,498), (2) an IPA (n = 109,577), or (3) Kaiser (n = 29,434) were selected.
The probability of at least 1 hospitalization, number of inpatient days given at least 1 hospitalization, and total inpatient days per year in the last 2 years of life were estimated for each subgroup. A 2-part regression model, which adjusted for age, sex, Medicaid status, race, ethnicity, and chronic condition associated with the last hospitalization, was applied to determine the HMO-FFS difference in inpatient utilization during the last 2 years of life.
During their last 2 years of life, decedents in IPAs and Kaiser used approximately 34% and 51% fewer inpatient days, respectively, than decedents in FFS.
Medicare beneficiaries who died while enrolled in an HMO, particularly Kaiser, had many fewer hospital days during the 2 years before death than beneficiaries who died with FFS coverage.
评估独立执业协会（IPA）模式的健康维护组织（HMO）以及凯撒基金会健康计划的团体模式对医疗保险受益人在生命最后两年住院率的影响，并与传统的按服务收费（FFS）保险进行比较。
医疗保险和医疗补助服务中心的数据与加利福尼亚州全州健康规划与发展办公室1991 - 2001年的住院出院数据相链接。选取了1998年1月至2001年6月期间死亡且在死亡前两年持续参保的老年医疗保险受益人样本，这些受益人分别参保于（1）FFS（n = 234,498）、（2）IPA（n = 109,577）或（3）凯撒（n = 29,434）。
估算每个亚组在生命最后两年中至少住院1次的概率、至少住院1次的住院天数以及每年的总住院天数。应用两部分回归模型，对年龄、性别、医疗补助状态、种族、族裔以及与最后一次住院相关的慢性病进行调整，以确定生命最后两年中HMO - FFS在住院率方面的差异。
在生命的最后两年中，IPA和凯撒的参保死者的住院天数分别比FFS参保死者少约34%和51%。
参保HMO（尤其是凯撒）的医疗保险受益人在死亡前两年的住院天数比参保FFS的受益人少得多。
