Heller Tamar, Owen Randall, Bowers Anne, Gibbons Hailee M
1 Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA.
Res Aging. 2017 Jul;39(6):778-798. doi: 10.1177/0164027516681049.
This study examines health services appraisal (HSA) and unmet health-care needs for adults (age 50 and over) with physical disabilities in Medicaid managed care (MMC) versus Medicaid fee for service (FFS). Surveys from 309 individuals in MMC and 349 in FFS 2 years after MMC implementation included demographics, MMC processes, HSA, and unmet health-care needs. Regression analyses with HSA and unmet health-care needs as outcomes included demographics and group status (MMC or FFS) for the entire sample, and demographics and MMC processes (continuity of care, experience with care coordinators and primary care physicians) as independent variables for only MMC enrollees. Group status was not associated with HSA or unmet needs. Among MMC enrollees, better health and more positive MMC processes related to higher HSA and lower unmet needs. It is important to consider the perspectives of people aging with disabilities in MMC to better serve their needs.
本研究考察了医疗补助管理式医疗（MMC）与医疗补助按服务收费（FFS）模式下，50岁及以上身体残疾成年人的健康服务评估（HSA）和未满足的医疗需求情况。在MMC实施两年后，对309名MMC参保者和349名FFS参保者进行了调查，内容包括人口统计学信息、MMC流程、HSA以及未满足的医疗需求。以HSA和未满足的医疗需求为结果的回归分析，对整个样本纳入了人口统计学信息和分组状态（MMC或FFS），而对于仅MMC参保者，以人口统计学信息和MMC流程（医疗连续性、与护理协调员及初级保健医生的就医体验）作为自变量。分组状态与HSA或未满足的需求无关。在MMC参保者中，健康状况较好以及MMC流程更为积极与更高的HSA和更低的未满足需求相关。考虑MMC中残疾老年人的观点对于更好地满足他们的需求很重要。
