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新英格兰地区双重资格受益人的关联数据分析

Linked Data Analysis of Dually Eligible Beneficiaries in New England.

作者信息

Saucier Paul, Bezanson Lee, Booth Maureen, Bratesman Stuart, Fralich Julie T, Gilden Daniel, Goldstein Elaina K, O'Connor Darlene, Perrone Christopher V, Willrich Katharine K

出版信息

Health Care Financ Rev. 1998 Winter;20(2):91-108.

PMID:25372133
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4194530/
Abstract

Analysis of linked Medicare/Medicaid data files from four New England States (Connecticut, Maine, Massachusetts, and New Hampshire) confirm that dually eligible beneficiaries used a disproportionate amount of both Medicare and Medicaid resources in 1995, driven largely by the significant subset of the population that used institutional long-term care (LTC). If States and the Federal Government are successful in developing approaches to dually eligible beneficiaries that reduce the use of institutional LTC, overall public costs per person could decline while Federal costs remained constant, and beneficiaries could have a greater selection of community-based options and experience greater satisfaction.

摘要

对来自新英格兰四个州(康涅狄格州、缅因州、马萨诸塞州和新罕布什尔州)的医疗保险/医疗补助关联数据文件进行分析后证实,在1995年,双重资格受益人群使用了不成比例的医疗保险和医疗补助资源,这在很大程度上是由使用机构长期护理(LTC)的大量人群所推动的。如果各州和联邦政府能够成功制定针对双重资格受益人的方法,减少机构长期护理的使用,那么在联邦成本保持不变的情况下,人均公共成本可能会下降,受益人可以有更多基于社区的选择,并获得更高的满意度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae6c/4194530/0a90f56b37d9/hcfr-20-2-091-g010.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae6c/4194530/0a90f56b37d9/hcfr-20-2-091-g010.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae6c/4194530/ff132cfeb021/hcfr-20-2-091-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae6c/4194530/f995ba99db2e/hcfr-20-2-091-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae6c/4194530/2a9a494aa434/hcfr-20-2-091-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae6c/4194530/df6d8cfc1896/hcfr-20-2-091-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae6c/4194530/0a90f56b37d9/hcfr-20-2-091-g010.jpg

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引用本文的文献

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Psychiatr Serv. 2011 Feb;62(2):186-93. doi: 10.1176/ps.62.2.pss6202_0186.
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Unintended impacts of a Medicaid prior authorization policy on access to medications for bipolar illness.

本文引用的文献

1
Improving the AAPCC (adjusted average per capita cost) with health-status measures from the MCBS (Medicare Current Beneficiary Survey).利用医疗保险当前受益人调查(MCBS)中的健康状况指标来改善调整后人均成本(AAPCC)。
Health Care Financ Rev. 1996 Spring;17(3):59-75.
2
Risk adjustment: where are we now?风险调整:我们目前处于什么状况?
Inquiry. 1998 Summer;35(2):122-31.
3
Medicare spending for elderly beneficiaries who need long-term care.医疗保险为需要长期护理的老年受益人支出的费用。
医疗补助事先授权政策对双相情感障碍药物获得的意外影响。
Med Care. 2010 Jan;48(1):4-9. doi: 10.1097/MLR.0b013e3181bd4c10.
Inquiry. 1997;34(4):302-10.
4
Disability and Medicare costs of elderly persons.老年人的残疾状况与医疗保险费用
Milbank Q. 1997;75(4):461-93. doi: 10.1111/1468-0009.00066.
5
Risk adjustment and Medicare: taking a closer look.风险调整与医疗保险:深入探讨
Health Aff (Millwood). 1997 Sep-Oct;16(5):26-43. doi: 10.1377/hlthaff.16.5.26.