Samson Lok Wong, Finegold Kenneth, Ahmed Azeem, Jensen Matthew, Filice Clara E, Joynt Karen E
Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC.
Med Care. 2017 Dec;55(12):e158-e163. doi: 10.1097/MLR.0000000000000606.
Disparities by economic status are observed in the health status and health outcomes of Medicare beneficiaries. For health services and health policy researchers, one barrier to addressing these disparities is the ability to use Medicare data to ascertain information about an individual's income level or poverty, because Medicare administrative data contains limited information about individual economic status. Information gleaned from other sources-such as the Medicaid and Supplemental Security Income programs-can be used in some cases to approximate the income of Medicare beneficiaries. However, such information is limited in its availability and applicability to all beneficiaries. Neighborhood-level measures of income can be used to infer individual-level income, but level of neighborhood aggregation impacts accuracy and usability of the data. Community-level composite measures of economic status have been shown to be associated with health and health outcomes of Medicare beneficiaries and may capture neighborhood effects that are separate from individual effects, but are not readily available in Medicare data and do not serve to replace information about individual economic status. There is no single best method of obtaining income data from Medicare files, but understanding strengths and limitations of different approaches to identifying economic status will help researchers choose the best method for their particular purpose, and help policymakers interpret studies using measures of income.
医疗保险受益人的健康状况和健康结果存在经济地位差异。对于卫生服务和卫生政策研究人员而言，解决这些差异的一个障碍是能否利用医疗保险数据来确定个人收入水平或贫困情况，因为医疗保险行政数据中关于个人经济状况的信息有限。在某些情况下，可以使用从其他来源（如医疗补助和补充保障收入计划）收集的信息来估算医疗保险受益人的收入。然而，此类信息的可用性及其对所有受益人的适用性都有限。邻里层面的收入衡量标准可用于推断个人层面的收入，但邻里聚集程度会影响数据的准确性和可用性。社区层面的经济状况综合衡量标准已被证明与医疗保险受益人的健康和健康结果相关，并且可能捕捉到与个体效应不同的邻里效应，但在医疗保险数据中不易获取，也不能用来替代关于个人经济状况的信息。从医疗保险档案中获取收入数据没有单一的最佳方法，但了解不同经济状况识别方法的优缺点将有助于研究人员为其特定目的选择最佳方法，并帮助政策制定者解读使用收入衡量标准的研究。
