Xu Wendy Yi, Jung Jeah Kyoungrae
Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Cunz Hall 208, 1841 Neil Avenue, Columbus, 43210, OH.
Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA.
Health Serv Res. 2017 Oct;52(5):1772-1793. doi: 10.1111/1475-6773.12559. Epub 2016 Sep 13.
Consuming low-value health care not only highlights inefficient resource use but also brings an important concern regarding the economics of disparities. We identify the relation of socioeconomic characteristics to the use of low-value cancer screenings in Medicare fee-for-service (FFS) settings, and quantify the amount subsidized from nonusers and taxpayers to users of these screenings.
2007-2013 Medicare Current Beneficiary Survey, Medicare FFS claims, and the Area Health Resource Files.
Our sample included enrollees in FFS Part B for the entire calendar year. We excluded beneficiaries with a claims-documented or self-reported history of targeted cancers, or those enrolled in Medicaid or Medicare Advantage plans. We identified use of low-value Pap smears, mammograms, and prostate-specific antigen tests based on established algorithms, and estimated a logistic model with year dummies separately for each test.
DATA COLLECTION/EXTRACTION METHODS: Secondary data analyses.
We found a statistically significant positive association between privileged socioeconomic characteristics and use of low-value screenings. Having higher income and supplemental private insurance strongly predicted more net subsidies from Medicare.
FFS enrollees who are better off in terms of sociodemographic characteristics receive greater subsidies from taxpayers for using low-value cancer screenings.
消费低价值医疗服务不仅凸显了资源利用效率低下的问题，还引发了对差异经济学的重要关注。我们确定社会经济特征与医疗保险按服务收费（FFS）环境中低价值癌症筛查使用之间的关系，并量化从非使用者和纳税人向这些筛查使用者提供补贴的金额。
2007 - 2013年医疗保险当前受益人调查、医疗保险FFS理赔数据以及地区卫生资源档案。
我们的样本包括全年参加FFS B部分的参保人。我们排除了有理赔记录或自我报告有特定癌症病史的受益人，以及参加医疗补助或医疗保险优势计划的受益人。我们根据既定算法确定低价值巴氏涂片检查、乳房X光检查和前列腺特异性抗原检测的使用情况，并分别针对每项检测估计了带有年份虚拟变量的逻辑模型。
数据收集/提取方法：二次数据分析。
我们发现社会经济特征优越与低价值筛查的使用之间存在统计学上显著的正相关关系。收入较高和拥有补充私人保险强烈预示着从医疗保险获得更多的净补贴。
在社会人口特征方面状况较好的FFS参保人因使用低价值癌症筛查而从纳税人那里获得了更多补贴。
