解释老年医疗保险受益人群中患有慢性阻塞性肺病的患者中胃食管反流病相关医疗费用增加的原因：成本分解分析。
Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis.
机构信息
Department of Pharmaceutical Systems and Policy, School of Pharmacy, School of Medicine, West Virginia University, Morgantown, WV, USA.
Department of Biostatistics and Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Int J Chron Obstruct Pulmon Dis. 2014 Apr 8;9:339-48. doi: 10.2147/COPD.S59139. eCollection 2014.
OBJECTIVE
To estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD) among elderly individuals with chronic obstructive pulmonary disease (COPD) and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder-Oaxaca linear decomposition technique.
METHODS
This study utilized a cross-sectional, retrospective study design, using data from multiple years (2006-2009) of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder-Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD.
RESULTS
Among elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001]) expenditures than did those with COPD/no GERD. Ordinary least squares regression revealed that individuals with COPD/GERD had 36.3% (P<0.001) higher expenditures than did those with COPD/no GERD. Overall, 30.9% to 43.6% of the differences in average health care expenditures were explained by differences in predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors between the two groups. Need factors explained up to 41% of the differences in average health care expenditures between the two groups.
CONCLUSION
Among elderly Medicare beneficiaries with COPD, the presence of GERD was associated with higher expenditures. Need factors primarily contributed to the differences in average health care expenditures, suggesting that the comanagement of chronic conditions may reduce excess health care expenditures associated with GERD.
目的
利用 Blinder-Oaxaca 线性分解技术，估计患有慢性阻塞性肺疾病（COPD）的老年人群中胃食管反流病（GERD）相关的超额医疗支出，并探讨易感性特征、使能资源、需求变量、个人医疗保健实践和外部环境因素对超额支出的贡献。
方法
本研究采用横断面、回顾性研究设计，利用 Medicare 现行受益调查（Medicare Current Beneficiary Survey）多年（2006-2009 年）的数据与按服务收费的 Medicare 索赔进行关联。使用诊断代码确定 COPD 和 GERD 的存在。医疗支出包括住院、门诊、处方药物、牙科、医疗服务提供者和其他服务。对于分析，使用 t 检验来检查 GERD 存在情况下，未经调整的亚组平均医疗支出差异。对对数变换后的医疗支出进行普通最小二乘回归，以估计与 GERD 相关的超额医疗支出。利用 Blinder-Oaxaca 线性分解技术，确定易感性特征、使能资源、需求变量、个人医疗保健实践和外部环境因素对与 GERD 相关的超额医疗支出的贡献。
结果
在患有 COPD 的老年 Medicare 受益人群中，29.3%的人群同时患有 GERD。患有 COPD/GERD 的老年 Medicare 受益人群的支出比患有 COPD/无 GERD 的人群高 1.5 倍（$36,793 比 $24,722[P<0.001]）。普通最小二乘回归显示，患有 COPD/GERD 的个体比患有 COPD/无 GERD 的个体的支出高 36.3%（P<0.001）。总体而言，两组之间在易感性特征、使能资源、需求变量、个人医疗保健实践和外部环境因素方面的差异解释了平均医疗支出差异的 30.9%至 43.6%。需求因素解释了两组之间平均医疗支出差异的 41%。
结论
在患有 COPD 的老年 Medicare 受益人群中，GERD 的存在与较高的支出相关。需求因素主要导致了平均医疗支出的差异，这表明对慢性疾病的共同管理可能会降低与 GERD 相关的超额医疗支出。
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