医疗保险受益人的观察状态、贫困与高财务负担

Observation Status, Poverty, and High Financial Liability Among Medicare Beneficiaries.

作者信息

Goldstein Jennifer N, Zhang Zugui, Schwartz J Sanford, Hicks LeRoi S

机构信息

Department of Medicine, Christiana Care Health System, Newark Del; The Value Institute, Christiana Care Health System, Newark, Del.

The Value Institute, Christiana Care Health System, Newark, Del.

出版信息

Am J Med. 2018 Jan;131(1):101.e9-101.e15. doi: 10.1016/j.amjmed.2017.07.013. Epub 2017 Jul 31.

DOI:10.1016/j.amjmed.2017.07.013

PMID:28774801

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5725232/

Abstract

BACKGROUND

Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation care compared with higher-income beneficiaries.

METHODS

We performed a retrospective, observational analysis of Medicare Part B claims and US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage for the full calendar year, with 1 or more observation stay(s), were included in the study. Beneficiaries were divided into quartiles representing poverty level. The associations between poverty quartile and high use of observation care and between poverty quartile and high financial liability for observation care were evaluated.

RESULTS

After multivariate adjustment, the risk of high use was higher for beneficiaries in the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial liability was higher in every poverty quartile compared with the wealthiest and peaked in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR, 1.17; 95% CI, 1.10-1.24).

CONCLUSIONS

Poverty predicts high use of observation care. The poor or near poor may be at highest risk for high liability.

摘要

背景

根据医疗保险B部分的规定，以观察状态住院的医疗保险受益人需承担费用分摊，且没有支出上限。由于低收入状况与住院率增加有关，人们担心这类受益人在观察护理方面可能面临更高的高使用率和自付费用风险。我们的目标是确定与高收入受益人相比，低收入医疗保险受益人在观察护理方面是否面临高使用率和高财务责任风险。

方法

我们对2013年医疗保险B部分的索赔数据和美国人口普查局的数据进行了回顾性观察分析。研究纳入了全年拥有A部分和B部分保险且有1次或更多次观察住院的医疗保险受益人。受益人被分为代表贫困水平的四分位数。评估了贫困四分位数与观察护理高使用率之间以及贫困四分位数与观察护理高财务责任之间的关联。

结果

经过多变量调整后，贫困（第三四分位数）和最贫困（第四四分位数）四分位数的受益人相比最富裕四分位数（第一四分位数）的受益人，高使用率风险更高（调整后的优势比[AOR]，1.21；95%置信区间[CI]，1.13 - 1.31；AOR，1.24；95% CI，1.16 - 1.33）。与最富裕的四分位数相比，每个贫困四分位数的高财务责任风险都更高，且在代表贫困但非最贫困受益人的第三四分位数中达到峰值（AOR，1.17；95% CI，1.10 - 1.24）。