Institute for Social Research, 426 Thompson Street, Room 3005, University of Michigan, Ann Arbor, MI 48104, USA.
Health Serv Res. 2011 Oct;46(5):1417-35. doi: 10.1111/j.1475-6773.2011.01275.x. Epub 2011 May 24.
To assess relationships between changes in Medicare Advantage (MA) payment rates and Medicare beneficiary hospitalizations and to simulate the effects of scheduled payment cuts on ambulatory care sensitive (ACS) and elective hospitalization rates.
State Inpatient Database discharge abstracts from Arizona, Florida, and New York merged with administrative Medicare enrollment and MA payment data.
Retrospective, fixed effect regression analysis of the relationship between MA payment rates and rates of ACS and elective hospitalizations among Medicare beneficiaries in counties with at least 10,000 Medicare beneficiaries and 3 percent MA penetration from 1999 to 2005.
MA payment rates were negatively related to rates of ACS admissions. Simulations suggest that payment cuts could be associated with higher rates of ACS admissions. No relationship between MA payments and rates of elective hospitalizations was found.
Reductions in MA payment rates may result in a small increase in ACS admissions. Trends in ACS admissions among chronically ill Medicare beneficiaries should be tracked following MA payment cuts.
评估医疗保险优势（MA）支付率变化与医疗保险受益人的住院治疗之间的关系，并模拟预定的支付削减对非住院治疗（ACS）和选择性住院治疗率的影响。
来自亚利桑那州、佛罗里达州和纽约州的住院患者数据库出院摘要，与行政性医疗保险登记和 MA 支付数据合并。
1999 年至 2005 年期间，对至少有 10000 名医疗保险受益人和 3%MA 渗透率的县，MA 支付率与医疗保险受益人的 ACS 和选择性住院治疗率之间的关系进行回顾性固定效应回归分析。
MA 支付率与 ACS 入院率呈负相关。模拟结果表明，支付削减可能与 ACS 入院率的升高有关。未发现 MA 支付与选择性住院治疗率之间存在关系。
MA 支付率的降低可能导致 ACS 入院率略有增加。在 MA 支付削减后，应跟踪慢性病医疗保险受益人的 ACS 入院趋势。
