Howard Steven W, Bernell Stephanie Lazarus, Wilmott Jennifer, Casim M Faizan, Wang Jing, Pearson Lindsey, Byler Caitlin M, Zhang Zidong
Health Management and Policy, Center for Outcomes Research, Saint Louis University , St. Louis, MO , USA.
Health Policy and Management, School of Social and Behavioral Health Services, Oregon State University , Corvallis, OR , USA.
Front Public Health. 2015 Oct 8;3:229. doi: 10.3389/fpubh.2015.00229. eCollection 2015.
The objective of this study is to explore the extent to which managed care market penetration in the United States is associated with the presence of chronic disease. Diabetes was selected as the chronic disease of interest due to its increasing prevalence as well as the disease management protocols that can lessen disease complications. We hypothesized that greater managed care market penetration would be associated with (1) lower prevalence of diabetes and (2) lower prevalence of diabetes-related comorbidities (DRCs) among diabetics. Data for this analysis came from two sources. We merged Medicare Advantage (MA) market penetration data from the Centers for Medicare and Medicaid Services (CMS) with data from the Medical Expenditure Panel Survey (MEPS) (2004-2008). Results suggest that county-level MA market penetration is not significantly associated with prevalence of diabetes or DRCs. That finding is quite interesting in that managed care market penetration has been shown to have an effect on utilization of inpatient services. It may be that managed care protocols do not offer the same benefits beyond the inpatient setting.
本研究的目的是探讨美国管理式医疗市场渗透率与慢性病存在之间的关联程度。由于糖尿病患病率不断上升以及疾病管理方案可减少疾病并发症，因此将糖尿病选为感兴趣的慢性病。我们假设更高的管理式医疗市场渗透率将与以下两点相关：（1）糖尿病患病率较低；（2）糖尿病患者中糖尿病相关合并症（DRC）的患病率较低。该分析的数据来自两个来源。我们将医疗保险和医疗补助服务中心（CMS）的医疗保险优势（MA）市场渗透率数据与医疗支出面板调查（MEPS）（2004 - 2008年）的数据进行了合并。结果表明，县级MA市场渗透率与糖尿病或DRC的患病率没有显著关联。这一发现相当有趣，因为管理式医疗市场渗透率已被证明对住院服务的利用有影响。可能是管理式医疗方案在住院环境之外无法提供同样的益处。
