Nuti Sudhakar V, Wang Yun, Masoudi Frederick A, Nunez-Smith Marcella, Normand Sharon-Lise T, Murugiah Karthik, Rodríguez-Vilá Orlando, Ross Joseph S, Krumholz Harlan M
*Yale School of Medicine †Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT ‡Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA §Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO ∥Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine ¶Section of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT #Department of Health Care Policy, Harvard Medical School, Boston, MA **Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT ††Cardiology Section and the Medical Service, VA Caribbean Healthcare System, San Juan, PR ‡‡Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine §§Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
Med Care. 2017 Oct;55(10):886-892. doi: 10.1097/MLR.0000000000000797.
Millions of Americans live in the US territories, but health outcomes and payments among Medicare beneficiaries in these territories are not well characterized.
Among Fee-for-Service Medicare beneficiaries aged 65 years and older hospitalized between 1999 and 2012 for acute myocardial infarction (AMI), heart failure (HF), and pneumonia, we compared hospitalization rates, patient outcomes, and inpatient payments in the territories and states.
Over 14 years, there were 4,350,813 unique beneficiaries in the territories and 402,902,615 in the states. Hospitalization rates for AMI, HF, and pneumonia declined overall and did not differ significantly. However, 30-day mortality rates were higher in the territories for all 3 conditions: in the most recent time period (2008-2012), the adjusted odds of 30-day mortality were 1.34 [95% confidence interval (CI), 1.21-1.48], 1.24 (95% CI, 1.12-1.37), and 1.85 (95% CI, 1.71-2.00) for AMI, HF, and pneumonia, respectively; adjusted odds of 1-year mortality were also higher. In the most recent study period, inflation-adjusted Medicare in-patient payments, in 2012 dollars, were lower in the territories than the states, at $9234 less (61% lower than states), $4479 less (50% lower), and $4403 less (39% lower) for AMI, HF, and pneumonia hospitalizations, respectively (P<0.001 for all).
Among Medicare Fee-for-Service beneficiaries, in 2008-2012 mortality rates were higher, or not significantly different, and hospital reimbursements were lower for patients hospitalized with AMI, HF, and pneumonia in the territories. Improvement of health care and policies in the territories is critical to ensure health equity for all Americans.
数以百万计的美国人生活在美国领土上，但这些领土上医疗保险受益人的健康状况和支付情况并未得到充分描述。
在1999年至2012年间因急性心肌梗死（AMI）、心力衰竭（HF）和肺炎住院的65岁及以上的按服务收费的医疗保险受益人中，我们比较了这些领土和各州的住院率、患者结局和住院费用。
在14年期间，这些领土上有4350813名独特的受益人，各州有402902615名。AMI、HF和肺炎的住院率总体呈下降趋势，且无显著差异。然而，在所有这三种情况下，这些领土上的30天死亡率更高：在最近一个时期（2008 - 2012年），AMI、HF和肺炎的30天死亡调整后比值分别为1.34 [95%置信区间（CI），1.21 - 1.48]、1.24（95% CI，1.12 - 1.37）和1.85（95% CI，1.71 - 2.00）；1年死亡调整后比值也更高。在最近的研究期间，按2012年美元计算，经通胀调整的医疗保险住院费用在这些领土上低于各州，AMI、HF和肺炎住院费用分别低9234美元（比各州低61%）、4479美元（低50%）和4403美元（低39%）（所有P<0.001）。
在2008 - 2012年期间，对于按服务收费的医疗保险受益人，这些领土上因AMI、HF和肺炎住院的患者死亡率更高或无显著差异，且医院报销费用更低。改善这些领土上的医疗保健和政策对于确保所有美国人的健康公平至关重要。
