美国预防服务工作组建议与医疗保险覆盖范围的比较。
Comparison between US Preventive Services Task Force recommendations and Medicare coverage.
机构信息
Department of Family Medicine, University of California, Los Angeles, CA, USA.
出版信息
Ann Fam Med. 2011 Jan-Feb;9(1):44-9. doi: 10.1370/afm.1194.
PURPOSE
The US Preventive Services Task Force (USPSTF) is authorized by the US government to review and disseminate the scientific evidence for clinical preventive services. The purpose of this study was to evaluate the alignment of Medicare preventive services coverage with the recommendations of the USPSTF before implementation of health reform.
METHODS
We recorded all Medicare coverage for preventive services as listed in the Medicare preventive services guide of 2007 (including the 2009 update) for all recommended (A-or B-rated) USPSTF and not recommended (D-rated) guidelines for preventive screening and counseling in adults aged 65 years and older. We analyzed 2 components of preventive care: preventive coordination (risk assessment, patient motivation, and arranging of preventive service) and the preventive service itself. The main outcome measure was the percentage of agreement between USPSTF recommendations and Medicare coverage.
RESULTS
The USPSTF recommended 15 preventive interventions for adults aged 65 years and older. Although Medicare partially reimbursed 93% of recommended services, full reimbursement for the preventive coordination, as well as the service, was available for only 7% of these services. This partial coverage is available mostly as part of the Welcome to Medicare Visit. Further, the USPSTF recommended against 16 preventive services; Medicare reimbursed clinicians for 44% of these services.
CONCLUSIONS
Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries.
目的
美国预防服务工作组（USPSTF）经美国政府授权，负责审查和传播临床预防服务的科学证据。本研究旨在评估医疗保险预防服务覆盖范围与 USPSTF 建议的一致性，以了解在实施医疗改革之前的情况。
方法
我们记录了 2007 年 Medicare 预防服务指南（包括 2009 年更新版）中所有推荐（A 级或 B 级）USPSTF 以及不推荐（D 级）成人（65 岁及以上）预防筛查和咨询指南中列出的所有 Medicare 预防服务覆盖范围。我们分析了预防保健的 2 个组成部分：预防协调（风险评估、患者动机和预防服务安排）和预防服务本身。主要结果指标是 USPSTF 建议与 Medicare 覆盖范围之间的一致性百分比。
结果
USPSTF 为 65 岁及以上成年人推荐了 15 项预防干预措施。尽管 Medicare 部分报销了 93%的推荐服务，但只有 7%的服务可全额报销预防协调以及服务费用。这种部分覆盖主要作为 Medicare 欢迎访问的一部分提供。此外，USPSTF 建议不提供 16 项预防服务；但 Medicare 为这些服务的 44%报销了临床医生的费用。
结论
需要重新评估 Medicare 预防服务的覆盖范围，特别关注预防协调。继续以前的做法可能会导致预防服务的提供不足和过度。新的医疗改革法有可能改善 Medicare 受益人的预防服务提供。
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