Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Health Aff (Millwood). 2013 Jul;32(7):1228-35. doi: 10.1377/hlthaff.2012.0773.
With quality-of-care bonus payments now available for Medicare Advantage health maintenance organizations (HMOs) and for accountable care organizations in traditional Medicare, the need to understand the relative quality of care delivered to Medicare enrollees has increased. We compared the quality of ambulatory care from 2003 through 2009 between beneficiaries enrolled in Medicare Advantage HMOs and those enrolled in traditional Medicare, and we assessed how the performance of various types of Medicare HMOs differed from that of traditional Medicare for these same measures. We found that beneficiaries in Medicare HMOs were consistently more likely than those in traditional Medicare to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. We also found that Medicare HMO physicians were rated less favorably by their patients than were physicians in traditional Medicare in 2003; however, by 2009 the opposite was true. Not-for-profit, larger, and older Medicare HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. Our results suggest that the positive effects of more-integrated delivery systems on the quality of ambulatory care in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.
随着医疗保险优势计划（Medicare Advantage）医疗机构和传统医疗保险中的问责制医疗机构的医疗保健质量奖金的发放，了解医疗保险参保人所接受的医疗保健的相对质量的需求有所增加。我们比较了 2003 年至 2009 年期间参加医疗保险优势计划 HMO 的受益人与参加传统医疗保险的受益人的门诊护理质量，并评估了各种类型的医疗保险 HMO 在这些相同措施上的表现与传统医疗保险的差异。我们发现，医疗保险 HMO 的参保人比传统医疗保险的参保人更有可能接受适当的乳腺癌筛查、糖尿病护理和心血管疾病的胆固醇检测。我们还发现，2003 年医疗保险 HMO 的医生比传统医疗保险的医生更不受患者的欢迎；然而，到 2009 年情况正好相反。非营利性、规模较大、成立时间较长的医疗保险 HMO 在临床措施和护理评估方面的表现一直优于营利性、规模较小、成立时间较短的 HMO。我们的研究结果表明，在医疗保险 HMO 中，更集成的交付系统对门诊护理质量的积极影响可能超过在定额支付下限制护理的潜在激励。
