Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA 02115, USA.
Med Care. 2013 May;51(5):389-95. doi: 10.1097/MLR.0b013e31827fef95.
Understanding Medicaid performance relative to private payers and among other states may lead to better value.
DESIGN, SETTING, AND PARTICIPANTS: Hospital Quality Alliance data from 2007-2008 were used to create composite "all-or-none" quality scores for nearly 900,000 nonelderly adult patients hospitalized with acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia.
Differences in the quality of care received by Medicaid compared with privately insured patients at the national and state levels.
Nationally, 88% of Medicaid beneficiaries received all appropriate processes of care when hospitalized for AMI, compared with 73% for CHF and 77% for pneumonia. Private patients received higher quality of care than Medicaid patients, but differences were small (1.3 percentage point difference, pneumonia; 2.7, AMI; 2.9, CHF; all P<0.05). At the state level, the differences averaged <3 percentage points across all conditions, but some states (2-8 states depending on the condition) exhibited significant (P<0.05) differences of >5 percentage points in favor of private patients. Two states exhibited significantly better quality of care for their Medicaid patients in excess of 5 percentage points. Quality scores for both Medicaid and private patients varied significantly by state but were highly correlated (correlations for AMI=0.80, CHF=0.84, pneumonia=0.80; all P<0.001).
Small national differences in quality between hospitalized Medicaid and private patients are promising, although merit close monitoring as states are forced to curb Medicaid reimbursements. Although quality for Medicaid patients varied by state, high correlations with private patients suggest that the factors driving quality have more to do with geographic factors in the delivery of hospital services than with state-established Medicaid policies.
了解医疗补助计划（Medicaid）相对于私人支付者和其他州的表现，可能会带来更好的价值。
设计、地点和参与者：使用 2007-2008 年医院质量联盟的数据，为近 90 万患有急性心肌梗死（AMI）、充血性心力衰竭（CHF）或肺炎的非老年成年住院患者创建了综合的“全部或全无”质量评分。
全国和州级医疗补助计划与私人保险患者接受的护理质量差异。
在全国范围内，88%的医疗补助计划受益人在因 AMI 住院时接受了所有适当的治疗过程，而 CHF 为 73%，肺炎为 77%。私人患者接受的护理质量高于医疗补助计划患者，但差异较小（肺炎为 1.3 个百分点，AMI 为 2.7 个百分点，CHF 为 2.9 个百分点；所有 P<0.05）。在州一级，所有情况下的差异平均<3 个百分点，但有些州（取决于病情，为 2-8 个州）表现出明显（P<0.05）的、有利于私人患者的>5 个百分点的差异。有两个州对其医疗补助计划患者的护理质量表现出明显优于 5 个百分点的改善。医疗补助计划和私人患者的质量评分在各州之间差异显著，但高度相关（AMI 的相关性为 0.80，CHF 的相关性为 0.84，肺炎的相关性为 0.80；所有 P<0.001）。
住院医疗补助计划和私人患者之间的质量差异很小，这是有希望的，尽管随着各州被迫控制医疗补助计划的报销，需要密切监测。尽管医疗补助计划患者的质量因州而异，但与私人患者的高度相关性表明，推动质量的因素更多地与提供医院服务的地理因素有关，而不是与州立医疗补助政策有关。
