Goldstein Jennifer N, Schwartz J Sanford, McGraw Patricia, Hicks LeRoi S
Department of Medicine & The Value Institute, Christiana Care Health System, 4755 Ogletown-Stanton Rd, Ammon Education Center Suite 2E70, Newark, DE, 19713, USA.
Division of General Internal Medicine, University of Pennsylvania, 1203 Blockley Hall, 423 Guardian Drive University, Philadelphia, PA, 19104, USA.
BMC Health Serv Res. 2019 Mar 7;19(1):149. doi: 10.1186/s12913-019-3982-8.
Medicare beneficiaries hospitalized under observation status have significant cost-sharing responsibilities under Medicare Part B. Prior work has demonstrated an association between increased cost-sharing and health care rationing among low-income Medicare beneficiaries. The objective of this study was to explore the potential impact of observation cost-sharing on future medical decision making of Medicare beneficiaries.
Single-center pilot cohort study. A convenience sample of Medicare beneficiaries hospitalized under observation status care was surveyed.
Out of 144 respondents, low-income beneficiaries were more likely to be concerned about the cost of their observation stay than higher-income respondents (70.7% vs29.3%, p = 0.015). If hospitalized under observation status again, there was a trend among low-income beneficiaries to request completion of their workup outside of the hospital (56.3% vs 43.8%), and to consider leaving against medical advice (AMA) (100% vs 0%), though these trends were not statistically significant (p = 0.30).
The results of this pilot study suggest that low-income Medicare beneficiaries hospitalized under observation status have greater concerns about their cost-sharing obligations than their higher income peers. Cost-sharing for observation care may have unintended consequences on utilization for low-income beneficiaries. Future studies should examine this potential relationship on a larger scale.
在观察状态下住院的医疗保险受益人在医疗保险B部分下有重大的费用分担责任。先前的研究表明，低收入医疗保险受益人的费用分担增加与医疗保健配给之间存在关联。本研究的目的是探讨观察费用分担对医疗保险受益人未来医疗决策的潜在影响。
单中心试点队列研究。对在观察状态护理下住院的医疗保险受益人进行便利抽样调查。
在144名受访者中，低收入受益人比高收入受访者更有可能担心其观察期的费用（70.7%对29.3%，p = 0.015）。如果再次在观察状态下住院，低收入受益人中有在院外完成检查的趋势（56.3%对43.8%），以及考虑自动出院（AMA）的趋势（100%对0%），尽管这些趋势没有统计学意义（p = 0.30）。
这项试点研究的结果表明，在观察状态下住院的低收入医疗保险受益人比高收入同龄人更担心其费用分担义务。观察护理的费用分担可能会对低收入受益人的医疗服务利用产生意想不到的后果。未来的研究应该在更大规模上研究这种潜在关系。
