Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 1200, Nashville, TN, 37203, USA.
Department of Health Services, Policy and Practice, Brown University, 121 South Main Street, Providence, RI, 02903, USA.
BMC Health Serv Res. 2017 Aug 29;17(1):611. doi: 10.1186/s12913-017-2558-8.
The initial days of a Medicare-covered skilled nursing facility (SNF) stay may have no cost-sharing or daily copayments depending on beneficiaries' enrollment in traditional Medicare or Medicare Advantage. Some policymakers have advocated imposing first-dollar cost-sharing to reduce post-acute expenditures. We examined the relationship between first-dollar cost-sharing for a SNF stay and use of inpatient and SNF services.
We identified seven Medicare Advantage plans that introduced daily SNF copayments of $25-$150 in 2009 or 2010. Copays began on the first day of a SNF admission. We matched these plans to seven matched control plans that did not introduce first-dollar cost-sharing. In a difference-in-differences analysis, we compared changes in SNF and inpatient utilization for the 172,958 members of intervention and control plans.
In intervention plans the mean annual number of SNF days per 100 continuously enrolled inpatients decreased from 768.3 to 750.6 days when cost-sharing changes took effect. Control plans experienced a concurrent increase: 721.7 to 808.1 SNF days per 100 inpatients (adjusted difference-in-differences: -87.0 days [95% CI (-112.1,-61.9)]). In intervention plans, we observed no significant changes in the probability of any SNF service use or the number of inpatient days per hospitalized member relative to concurrent trends among control plans.
Among several strategies Medicare Advantage plans can employ to moderate SNF use, first-dollar SNF cost-sharing may be one influential factor.
Not applicable.
根据受益人是否参加传统医疗保险或医疗保险优势计划，医疗保险涵盖的疗养院（SNF）入住初期可能无需分担费用或支付每日共同支付额。一些政策制定者主张实行首付费用分担制，以减少急性后期的支出。我们研究了疗养院住院首付费用分担与住院和疗养院服务使用之间的关系。
我们确定了 2009 年或 2010 年有 7 种医疗保险优势计划引入每日疗养院共同支付额 25-150 美元的计划。共同支付额从疗养院入住的第一天开始。我们将这些计划与没有引入首付费用分担的 7 个匹配对照计划进行匹配。在差异中的差异分析中，我们比较了干预组和对照组中 172958 名成员的疗养院和住院利用率的变化。
在干预计划中，当成本分担变化生效时，每 100 名连续住院患者的平均疗养院日数从 768.3 天减少到 750.6 天。对照计划同时出现增加：每 100 名住院患者的疗养院日数从 721.7 天增加到 808.1 天（调整后的差异中的差异：-87.0 天[95%置信区间（-112.1，-61.9）]）。在干预计划中，与对照计划中的同期趋势相比，我们没有观察到任何疗养院服务使用的概率或每个住院成员的住院天数发生任何显著变化。
在医疗保险优势计划可以采用的几种调节疗养院使用的策略中，首付疗养院费用分担可能是一个有影响力的因素。
不适用。
