Welberry Heidi, Barr Margo Linn, Comino Elizabeth J, Harris-Roxas Ben F, Harris Elizabeth, Harris Mark Fort
Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, University of New South Wales, Sydney, NSW 2052, Australia.
Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, University of New South Wales, Sydney, NSW 2052, Australia; and Corresponding author. Email:
Aust J Prim Health. 2019 Apr;25(2):168-175. doi: 10.1071/PY18113.
The number of older people living with chronic health conditions is increasing in Australia. The Chronic Disease Management (CDM) items program was introduced to the Medicare Benefits Schedule (MBS) to encourage a more structured approach to managing patients with chronic conditions. Initial uptake was slow and recent research has suggested that uptake is decreasing. This paper examines: person MBS CDM claims in NSW between 2006 and 2014 - using baseline survey data (2006-09) from the Sax Institute's 45 and Up Study linked to MBS and Death Registry data (2006-14) - and MBS CDM claims per 100000 population - using billing data sourced from the Medicare Australia Statistics website - to systematically examine any changes in uptake using a time-series analysis. After age adjustment, claims for initial plans increased from 11.3% in 2006 to 22.4% in 2014. Increases were also seen for allied health service claims (from 4.1% in 2006 to 20.8% in 2014) and for plan reviews (from 5.9% in 2006 to 16.0% in 2014). These increases were consistent with the MBS summary claims data. There is evidence that these plans are appropriately targeting those in most need; however, there is limited evidence of their effect. Claims for plan reviews, although increasing, are suboptimal and may indicate poor continuity of care.
在澳大利亚，患有慢性健康问题的老年人数量正在增加。慢性病管理（CDM）项目被引入到医疗保险福利计划（MBS）中，以鼓励采用更具结构性的方法来管理慢性病患者。最初的参与率较低，最近的研究表明参与率正在下降。本文进行了以下研究：利用萨克斯研究所“45岁及以上研究”的基线调查数据（2006 - 2009年）与MBS及死亡登记数据（2006 - 2014年），分析新南威尔士州2006年至2014年期间个人的MBS CDM索赔情况；利用从澳大利亚医疗保险统计网站获取的计费数据，分析每10万人口的MBS CDM索赔情况，通过时间序列分析系统地研究参与率的任何变化。经过年龄调整后，初始计划的索赔率从2006年的11.3%增至2014年的22.4%。辅助医疗服务索赔（从2006年的4.1%增至2014年的20.8%）和计划审查（从2006年的5.9%增至2014年的16.0%）也有所增加。这些增长与MBS汇总索赔数据一致。有证据表明这些计划适当地针对了最需要的人群；然而，其效果的证据有限。计划审查的索赔虽然在增加，但并不理想，可能表明护理的连续性较差。
