Soria-Saucedo Rene, Xu Peng, Newsom Jack, Cabral Howard, Kazis Lewis E
The Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Boston, United States of America.
CenseoHealth, Dallas, United States of America.
PLoS One. 2016 Jan 4;11(1):e0145656. doi: 10.1371/journal.pone.0145656. eCollection 2016.
The Affordable Care Act set in motion a renewed emphasis on quality of care evaluation. However, the evaluation strategies of quality by the Centers for Medicare and Medicaid Services do not consider geography when comparisons are made among plans. Using an overall measure of a plan's quality in the public sector--the Medicare Advantage (MA) star ratings--we explored the impact of geography in these ratings. We identified 2,872 U.S counties in 2010. The geographic factor predicted a larger fraction of the MA ratings' compared to socio-demographic factors which explained less. Also, after the risk adjustments, almost half of the U.S. states changed their ranked position in the star ratings. Further, lower MA star ratings were identified in the Southeastern region. These findings suggest that the geographic component effect on the ratings is not trivial and should be considered in future adjustments of the metric, which may enhance the transparency, accountability, and importantly level the playing field more effectively when comparing quality across health plans.
《平价医疗法案》推动了对医疗质量评估的重新重视。然而，医疗保险和医疗补助服务中心对质量的评估策略在比较不同计划时并未考虑地理位置因素。我们使用公共部门中一项衡量计划质量的综合指标——医疗保险优势（MA）星级评定，来探究地理位置在这些评定中的影响。我们确定了2010年美国的2872个县。与社会人口统计学因素相比，地理因素对MA星级评定的预测占比更大，而社会人口统计学因素的解释力较小。此外，在进行风险调整后，几乎一半的美国州在星级评定中的排名发生了变化。此外，东南部地区的MA星级评定较低。这些发现表明，地理因素对评定的影响并非微不足道，在该指标未来的调整中应予以考虑，这可能会提高透明度、增强问责制，并且在比较不同健康计划的质量时更有效地营造公平的竞争环境。
