Alexander G Caleb, Schiman Cuiping, Kaestner Robert
1 Johns Hopkins University, Baltimore, MD, USA.
2 Northwestern University, Chicago, IL, USA.
Med Care Res Rev. 2018 Apr;75(2):153-174. doi: 10.1177/1077558716681920. Epub 2016 Dec 1.
Medicare Part D was associated with reduced hospitalizations, yet little is known whether these effects varied across patients and how Part D was associated with length of stay and inpatient expenditures. We used Medicare claims and the Medicare Current Beneficiary Survey from 2002 to 2010 and an instrumental variables approach. Gaining drug insurance through Part D was associated with a statistically significant 8.0% reduction in likelihood of admission across conditions examined. Reductions were generally greater for younger, healthier, and male individuals. Across all conditions, mean length of stay decreased by 3.2% from a baseline of 5.1 days. Part D was associated with a 3.5% reduction in expenditures per admission, reflecting a decrease of $844 from a mean charge of $24,124 per admission prior to Part D. Thus, Part D was associated with statistically and clinically significant reductions in the probability of admission and length of stay for several common conditions.
医疗保险D部分与住院率降低相关,但对于这些影响在不同患者中是否存在差异以及D部分与住院时间和住院费用之间的关联,我们却知之甚少。我们使用了2002年至2010年的医疗保险理赔数据和医疗保险当前受益调查,并采用了工具变量法。通过D部分获得药品保险与在所研究的各种病症中入院可能性在统计学上显著降低8.0%相关。对于年轻、健康的男性个体,住院率的降低幅度通常更大。在所有病症中,平均住院时间从基线的5.1天减少了3.2%。D部分与每次入院费用降低3.5%相关,这反映出在D部分实施之前每次入院平均费用为24,124美元,现在减少了844美元。因此,D部分与几种常见病症的入院概率和住院时间在统计学和临床上均有显著降低相关。