Rehabilitation Outcomes Research Center, Research Enhancement Award Program, North Florida/South Georgia Veterans Health System, 1601 SW Archer Road, Gainesville, FL 32608, USA.
Med Care. 2010 Jun;48(6):558-62. doi: 10.1097/MLR.0b013e3181bd4a11.
The increase in provision of assistive technology devices (ATDs) has spurred controversy over Medicare policy aimed at reducing cost-policy that forces social isolation and conflicts with legislation, facilitating participation for individuals with disabilities. In contrast, Department of Veterans Affairs (VA) policy does not limit provision of AT to "in home" use only but rather, states "all enrolled and some non-enrolled veterans are eligible for all needed prosthetics."
Examine ATD provision policy by comparing 2 systems, Medicare and VA. Empirically analyze differences in ATDs provided, cost, and duplication in provision.
Retrospective study of VA databases, including VA Medicare data.
A population based study of 12,0461 veterans post-stroke.
Frequency of provision of ATDs by Health Care Common Procedural Code, purchase price, and capped rental payments.
Of the poststroke veteran cohort, 39% received no AT, 56% received AT from the VA only, 1% received AT from Medicare only, and 3% received AT from both the VA and Medicare. Most ATDs were for activities of daily living, followed by walkers/canes/crutches. In specific ATD comparisons, VA costs were substantially lower than Medicare for purchased items and slightly lower than Medicare for capped rental payments.
VA provides a broader variety of ATDs at a lesser cost than Medicare. Analyses of policy differences between VA and Medicare suggest VA policy is driven by veteran need whereas Medicare policy is driven at least in part, by containing costs that have skyrocketed as a result of fraudulent claims.
辅助技术设备（ATD）的供应增加引发了针对医疗保险政策的争议，该政策旨在降低成本，但这一政策导致了社交隔离，与立法相冲突，不利于残疾人的参与。相比之下，美国退伍军人事务部（VA）的政策并不限制 ATD 的供应仅限于“家庭内”使用，而是规定“所有注册和一些未注册的退伍军人都有资格获得所有需要的假肢”。
通过比较医疗保险和 VA 这两个系统，来研究 ATD 的供应政策。对提供的 ATD、成本和供应重复的差异进行实证分析。
对 VA 数据库进行回顾性研究，包括 VA 医疗保险数据。
一项基于人群的 120461 名中风后退伍军人的研究。
按医疗保健通用程序代码、购买价格和最高租金支付额来衡量 ATD 的提供频率。
在中风后退伍军人队列中，39%的人没有接受 ATD，56%的人仅从 VA 获得 ATD，1%的人仅从医疗保险获得 ATD，3%的人从 VA 和医疗保险都获得了 ATD。大多数 ATD 用于日常生活活动，其次是助行器/手杖/拐杖。在特定的 ATD 比较中，VA 的购买成本比医疗保险低得多，而最高租金支付则略低于医疗保险。
VA 提供的 ATD 种类更广泛，成本也比医疗保险低。对 VA 和医疗保险政策差异的分析表明，VA 政策是由退伍军人的需求驱动的，而医疗保险政策至少部分是由控制成本驱动的，这些成本由于欺诈性索赔而急剧上升。
