Yale University, School of Public Health 60 College Street, New Haven, CT.
RAND Corporation, Santa Monica, CA.
Med Care. 2019 Jan;57(1):8-12. doi: 10.1097/MLR.0000000000001000.
Previous studies found lower hospitalization rates for enrollees in Medicare Advantage (MA) plans than for beneficiaries with fee-for-service (FFS) coverage. MA enrollment is increasing, especially for those newly eligible for Medicare, but little is known about how service use in FFS or MA differs for new beneficiaries.
To compare differences in rates of hospitalization between MA and FFS.
A retrospective study of hospitalization among FFS and MA respondents to the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey. Differences in hospitalization rates were assessed using multivariable logistic regression models that controlled for patient sociodemographic and health characteristics. Models included an interaction between age and coverage type to determine whether patterns of care were distinct for enrollees recently eligible for Medicare.
In total, 259,335 respondents to the 2013 MCAHPS survey.
In total, 14% of FFS and 12% of MA enrollees had ≥1 hospitalization in the 6 months before survey administration. Models adjusted for enrollee demographics found that MA enrollees had 0.81 the odds of being hospitalized relative to those with FFS coverage (95% confidence interval, 0.78-0.84). Differences between groups were substantially reduced and no longer statistically significant when they were fully adjusted (adjusted odds ratio 1.01, 95% confidence interval, 0.97-1.08). Models with interactions indicated no significant age differences in the MA/FFS hospitalization gap.
Differences in hospital admissions between those with MA and FFS coverage appear to be primarily related to differences in health status.
先前的研究发现，参加医疗保险优势计划（MA）的参保人住院率低于采用按服务收费（FFS）的参保人。MA 的参保人数正在增加，尤其是对新符合条件的 Medicare 的参保人，但对于新受益人而言，FFS 或 MA 中的服务使用有何不同知之甚少。
比较 MA 和 FFS 之间住院率的差异。
这是一项对 Medicare 消费者评估医疗保健提供者和系统（MCAHPS）调查中 FFS 和 MA 受访者住院情况的回顾性研究。使用多变量逻辑回归模型评估住院率差异，该模型控制了患者的社会人口统计学和健康特征。模型中包括年龄和覆盖类型之间的交互作用，以确定 Medicare 新受益人是否存在独特的护理模式。
共有 259335 名参加 2013 年 MCAHPS 调查的受访者。
共有 14%的 FFS 和 12%的 MA 参保人在调查前 6 个月内至少有 1 次住院治疗。调整参保人人口统计学特征的模型发现，MA 参保人住院的可能性比 FFS 参保人低 0.81（95%置信区间，0.78-0.84）。当完全调整后，组间差异显著减小且不再具有统计学意义（调整后的优势比为 1.01，95%置信区间，0.97-1.08）。带有交互作用的模型表明，MA/FFS 住院差距在年龄上无显著差异。
MA 和 FFS 覆盖人群之间的住院差异似乎主要与健康状况的差异有关。
