Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA.
Health Aff (Millwood). 2013 Mar;32(3):552-61. doi: 10.1377/hlthaff.2012.0851.
Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-08, and individual Medicare claims, and overcoming limitations of previous work, we found $2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: $2,650, $5,040, and $6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit.
尽管医疗保险临终关怀福利已被证明既能提高护理质量又能降低成本，但人们一直认为，只有在患者去世前 53-105 天登记入组的情况下，该福利才会产生节省。我们利用来自 2002-08 年健康与退休研究的数据和个人医疗保险索赔记录，并克服了之前工作的局限性，发现与匹配的非临终关怀对照组相比，每位在去世前 53-105 天登记入组的临终关怀患者，医疗保险可节省 2561 美元。然而，在更常见的、较短的登记期内，节省的幅度更高：分别为每位登记入组 1-7 天、8-14 天和 15-30 天的患者节省 2650 美元、5040 美元和 6430 美元。在所有检查的时间段内，临终关怀患者的住院服务使用和院内死亡比例也明显低于匹配对照组。医疗保险和医疗补助服务中心不应该试图限制 Medicare 临终关怀的参与，而应该专注于确保有意愿享受该福利的合格患者及时登记入组。
