Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA, United States; Harvard Medical School, Department of Medicine, Boston, MA, United States; Brigham and Women's Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, United States.
Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Boston, MA, United States; VA Boston Healthcare System, Boston University School of Public Health, Boston, MA, United States.
Healthc (Amst). 2017 Dec;5(4):165-170. doi: 10.1016/j.hjdsi.2017.05.001. Epub 2017 Jul 1.
Given that health care costs in Massachusetts continue to grow despite great efforts to contain them, we seek to understand characteristics and spending patterns of the costliest non-elderly adults in Massachusetts based on type of insurance.
We used the Massachusetts All-Payer Claims Database (APCD) from 2012 and analyzed demographics, utilization patterns and spending patterns across payers (Medicaid, Medicaid managed care, and private insurers) for high cost patients (those in the top 10% of spending) and non-high cost patients (the remaining 90%).
We identified 3,712,045 patients between the ages of 18-64 years in Massachusetts in 2012 who met our inclusion criteria. Of this group, 8.5% had Medicaid fee-for-service, 11.1% had Medicaid managed care, and 80.3% had private insurance. High cost patients accounted for 65% of total spending in our sample. We found that high cost patients were more likely to be older (median age 48 vs 40, p<0.001), female (60.2% vs. 51.2%, p<0.001), and have multiple chronic conditions (4.4 vs. 1.3, p<0.001) compared to non-high cost patient patients. Medicaid patients were the most likely to be designated high cost (18.1%) followed by Medicaid managed care (MCO) (13.9%) and private insurance (8.6%). High cost Medicaid patients also had the highest mean annual spending and incurred the most preventable spending compared to high cost MCO and high cost private insurance patients.
CONCLUSIONS & IMPLICATIONS: We used 2012 claims data from Massachusetts to examine characteristics and spending patterns of the state's costliest patients based on type of insurance. Providers and policymakers seeking to reduce costs and increase value under delivery system reform may wish to target the Medicaid population.
尽管马萨诸塞州已经付出了巨大努力来控制医疗保健成本，但这些成本仍在持续增长。因此，我们试图根据保险类型了解马萨诸塞州最昂贵的非老年成年人的特征和支出模式。
我们使用了 2012 年的马萨诸塞州所有支付者索赔数据库（APCD），并分析了高成本患者（支出最高的 10%）和非高成本患者（其余 90%）的不同支付者（医疗补助、医疗补助管理式医疗和私人保险公司）的人口统计学、利用模式和支出模式。
我们在 2012 年确定了马萨诸塞州 18-64 岁之间符合我们纳入标准的 3712045 名患者。其中，8.5%的人有医疗补助服务费用，11.1%的人有医疗补助管理式医疗，80.3%的人有私人保险。高成本患者占我们样本总支出的 65%。我们发现，高成本患者更可能年龄较大（中位数年龄为 48 岁，而 40 岁，p<0.001），女性（60.2%，而 51.2%，p<0.001），并有多种慢性疾病（4.4 种，而 1.3 种，p<0.001）与非高成本患者相比。医疗补助患者被指定为高成本的可能性最高（18.1%），其次是医疗补助管理式医疗（MCO）（13.9%）和私人保险（8.6%）。高成本医疗补助患者的年平均支出最高，与高成本 MCO 和高成本私人保险患者相比，支出的可预防部分也最多。
我们使用了 2012 年马萨诸塞州的索赔数据，根据保险类型检查了该州最昂贵患者的特征和支出模式。在实施医疗交付系统改革以降低成本和提高价值的过程中，服务提供商和政策制定者可能希望将目标对准医疗补助人群。
