Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland.
Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland.
Am J Prev Med. 2018 Jan;54(1):37-43. doi: 10.1016/j.amepre.2017.08.030. Epub 2017 Nov 11.
To encourage greater utilization of preventive services among Medicare beneficiaries, the 2010 Affordable Care Act waived coinsurance for the Welcome to Medicare visit, making this benefit free starting in 2011. The objective of this study was to determine the impact of the Affordable Care Act on Welcome to Medicare visit utilization.
A 5% sample of newly enrolled fee-for-service Medicare beneficiaries for 2005-2016 was used to estimate changes in Welcome to Medicare visit use over time. An interrupted time series model examined whether Welcome to Medicare visits increased significantly after 2011, controlling for pre-intervention trends and other autocorrelation.
Annual Welcome to Medicare visit rates began at 1.4% in 2005 and increased to 12.3% by 2016. The quarterly Welcome to Medicare visit rate, which was almost 1% at baseline, was increasing by 0.06% before the 2011 Affordable Care Act provision (p<0.001). Immediately following the 2011 Affordable Care Act provision, the rate increased by about 1% in the first quarter of 2011 (intercept, p<0.001), followed by an increase of 0.13% every subsequent quarter (slope, p<0.001). This general trend was observed in subgroup analyses, although this trend varied by subgroups where the pre-Affordable Care Act trends of lower utilization persisted over time for non-whites and improved less quickly for men, regions other than Northeast, and beneficiaries without any supplemental insurance.
The Affordable Care Act, and perhaps the removal of cost sharing, was associated with increased use of the Welcome to Medicare visit; however, even with the increased use, there is room for improvement.
为鼓励更多的 Medicare 受惠者利用预防服务，2010 年平价医疗法案豁免了 Medicare 新参保者初始访视的自付额，使这项福利从 2011 年开始免费。本研究的目的是确定平价医疗法案对 Medicare 新参保者初始访视利用率的影响。
使用 2005-2016 年新加入按服务收费 Medicare 的 5%的样本，估计随时间推移 Medicare 新参保者初始访视利用率的变化。采用中断时间序列模型，在控制干预前趋势和其他自相关的情况下，检验 2011 年后 Medicare 新参保者初始访视是否显著增加。
2005 年初始访视率每年为 1.4%，到 2016 年增加到 12.3%。基线时初始访视季度率接近 1%，在 2011 年平价医疗法案条款出台前（p<0.001），每季度增加 0.06%。在 2011 年平价医疗法案条款出台后，2011 年第一季度率立即增加了约 1%（截距，p<0.001），随后每个后续季度增加 0.13%（斜率，p<0.001）。虽然这种趋势在亚组分析中有所不同，但在非白人的使用率一直较低且男性、东北以外地区和没有任何补充保险的受惠者的改善速度较慢的亚组中，这一总体趋势仍然存在。
平价医疗法案，也许是成本分担的取消，与 Medicare 新参保者初始访视利用率的增加有关；然而，即使利用率增加了，仍有改进的空间。
