Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.).
Ann Intern Med. 2019 Jun 18;170(12):837-844. doi: 10.7326/M18-2467. Epub 2019 May 28.
Identifying factors that affect variation in health care spending among older adults with disability may reveal opportunities to better address their care needs while offsetting excess spending.
To quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household activities, mobility, or self-care.
Observational study of in-person interviews and linked Medicare claims.
United States, 2015.
3716 community-living older adults who participated in the 2015 NHATS (National Health and Aging Trends Study) and survived for 12 months.
Total Medicare spending by spending quartile in multivariable regression models that adjusted for individual characteristics.
Negative consequences were experienced by 18.3% of participants with disability in household activities, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences due to household ($4866 vs. $4095), mobility ($7266 vs. $4115), and self-care ($10 935 vs. $4436) disability versus those who did not. In regression-adjusted analyses, median spending did not differ appreciably for participants who experienced negative consequences in household activities ($338 [95% CI, -$768 to $1444]), but was higher for those with mobility ($2309 [CI, $208 to $4409]) and self-care ($3187 [CI, $432 to $5942]) disability. In the bottom-spending quartile, differences were observed for self-care only ($1460 [CI, $358 to $2561]). No differences were observed in the top quartile.
This observational study could not establish causality.
Inadequate support for mobility and self-care is associated with higher Medicare spending, especially in the middle and lower ends of the spending distribution. Better support for the care needs of older adults with disability could offset some Medicare spending.
The Commonwealth Fund.
确定影响残疾老年人医疗保健支出差异的因素，可能揭示出在满足其护理需求的同时，减少过度支出的机会。
通过评估日常生活活动、移动能力或自理能力支持不足对医疗保险支出的影响，量化残疾老年人医疗保险支出的差异。
对面对面访谈和医疗保险索赔进行的观察性研究。
美国，2015 年。
3716 名居住在社区的 2015 年 NHATS（国家健康老龄化趋势研究）参与者，随访 12 个月后存活。
使用多变量回归模型，根据个人特征对医疗保险支出进行四分位距分析。
18.3%的残疾参与者在日常生活活动中经历了负面后果，25.6%的参与者在移动能力方面，20.0%的参与者在自理能力方面。与没有经历负面后果的参与者相比，因日常生活活动（$4866 比 $4095）、移动能力（$7266 比 $4115）和自理能力（$10935 比 $4436）残疾而经历负面后果的参与者的医疗保险中位数支出更高。在调整后的回归分析中，经历日常生活活动负面后果的参与者的中位支出没有显著差异（$338 [95%CI，-$768 到 $1444]），但移动能力（$2309 [CI，$208 到 $4409]）和自理能力（$3187 [CI，$432 到 $5942]）残疾的参与者的支出更高。在支出最低的四分位数中，仅在自理能力方面观察到差异（$1460 [CI，$358 到 $2561]）。在支出最高的四分位数中没有观察到差异。
本观察性研究不能确定因果关系。
移动能力和自理能力支持不足与医疗保险支出较高相关，特别是在支出分布的中低端。更好地满足残疾老年人的护理需求可以抵消部分医疗保险支出。
英联邦基金会。
