Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, Massachusetts.
Department of Health Policy, London School of Economics and Political Science, London, United Kingdom.
JACC Heart Fail. 2019 Jan;7(1):56-62. doi: 10.1016/j.jchf.2018.10.001. Epub 2018 Dec 12.
This study examined longitudinal trends in types of payers for adult heart transplantations in the United States.
In the last decade, volume of heart transplantations in the United States has substantially increased, a trend that has coincided with Medicaid expansion and greater insurance coverage in the general U.S.
Limited data are available characterizing the changes in payer mix supporting these recent increases in heart transplantation activity.
De-identified data were obtained from the Organ Procurement and Transplantation Network for heart transplantation recipients 18 to 64 years of age in the United States between 1997 and 2017. Primary sources of insurance payment were determined at the time of transplantation in aggregate and stratified by sex and race. Changes in volume and payer mix of patients added to the candidate waitlist between 1997 and 2017 were also examined.
A total of 36,340 adults from 18 to 64 years of age underwent heart transplantations between 1997 and 2017. Support by public payer insurance increased from 28.2% (in 1997) to a peak of 48.8% (in 2016). Medicaid coverage increased from 9.4% in 1997 to 15.5% in 2007 and remained stable to 2017 (14.7%; β-coefficient: +0.23% [0.04]; p < 0.001 for trend). Medicare beneficiaries accounted for 18.2% of recipients in 1997, 22% in 2007, and 30.3% in 2016 (β-coefficient: +0.60% [0.06]; p < 0.001 for trend). The proportion of transplantation candidates receiving Medicare coverage increased over time across all races and both sexes. Similar aggregate patterns were observed in waitlist trends for adult heart transplantation candidates.
Public payer insurance has emerged as an increasingly dominant source of funding for adult heart transplantations in the United States, supporting nearly half of all transplants in 2017.
本研究在美国探讨成人心脏移植中各种支付者类型的纵向趋势。
在过去十年中，美国的心脏移植量大幅增加，这一趋势与医疗补助计划的扩大以及美国整体保险覆盖范围的扩大相吻合。
目前可用的数据有限，无法描述支持最近心脏移植活动增加的支付者组合的变化。
从美国器官获取与移植网络获得 1997 年至 2017 年期间 18 至 64 岁成人心脏移植受者的去识别数据。在移植时按性别和种族对保险支付的主要来源进行了汇总和分层。还检查了 1997 年至 2017 年期间候选等候名单中新增患者的数量和支付者组合的变化。
1997 年至 2017 年间，共有 36340 名 18 至 64 岁的成年人接受了心脏移植。公共支付者保险的支持率从 1997 年的 28.2%上升到 2016 年的 48.8%。1997 年，医疗补助计划的覆盖率从 9.4%上升到 2007 年的 15.5%，并保持稳定至 2017 年（14.7%；β系数：+0.23%[0.04]；p<0.001）。1997 年，医疗保险受益人为 18.2%的受者，2007 年为 22%，2016 年为 30.3%（β系数：+0.60%[0.06]；p<0.001）。随着时间的推移，所有种族和性别接受医疗保险的移植候选者比例都有所增加。成人心脏移植候选者等候名单的趋势也呈现出类似的总体模式。
公共支付者保险已成为美国成人心脏移植的主要资金来源，2017 年约有一半的移植手术由其提供资金。
