Julie P. W. Bynum (
Andrea Austin is a research scientist at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
Health Aff (Millwood). 2017 Jul 1;36(7):1309-1317. doi: 10.1377/hlthaff.2017.0157.
Health care spending is generally highest among people who need both complex medical care and long-term services and supports, such as adults dually eligible for Medicare and Medicaid. Understanding how different types of complex patients use services over time can inform policies that target this population. High combined Medicare and Medicaid spending are found in two distinct groups of high-cost dual eligibles: older beneficiaries who are nearing the end of life, and younger beneficiaries with sustained need for functional supports. However, both groups have high hospitalization costs. Among high-cost dual eligibles living in the community, those who are older spend less on home and community-based services than those who are younger. Greater use of such services might provide stable support in the last year or two of life, when illness and functional decline accelerate. Tailored approaches to each population's distinct needs could yield care of increased value to patients and their families, with the potential to lower costs if patients' needs can be met with fewer stays in short-term inpatient facilities.
医疗保健支出通常在需要复杂的医疗护理和长期服务和支持的人群中最高，例如同时有资格获得医疗保险和医疗补助的成年人。了解不同类型的复杂患者如何随时间使用服务可以为针对该人群的政策提供信息。在两个不同的高成本双重合格人群中发现了高合并医疗保险和医疗补助支出：接近生命尽头的老年受益人，以及持续需要功能支持的年轻受益人。然而，这两个群体都有很高的住院费用。在社区中生活的高成本双重合格者中，年龄较大的人在家庭和社区为基础的服务上的支出低于年龄较小的人。在生命的最后一两年或两年中，更多地使用这些服务可能会提供稳定的支持，因为疾病和功能下降会加速。针对每个群体的独特需求制定的量身定制的方法可以为患者及其家人提供增加价值的护理，并有可能降低成本，如果患者的需求可以通过减少短期住院治疗来满足的话。
