Li Tao, Johnson Samuel T, Koester Michael C, Hommel Annie, Norcross Marc F
1Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA.
2Kinesiology Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA.
Inj Epidemiol. 2019 May 1;6:15. doi: 10.1186/s40621-019-0194-y. eCollection 2019.
Increasing athletic trainer (AT) services in high schools has attracted widespread interest across the nation as an effective instrument to manage injuries and improve children's health, but there is a lack of evidence on potential medical savings. Our study aimed to address this knowledge gap and provide evidence of AT impacts on medical payments and utilizations to inform public policy decision.
We obtained medical claims of patients aged 14 to 18 years from the 2011-2014 Oregon All Payer All Claims limited dataset. We calculated payer payments and utilizations for medical claims under AT's scope of practice. We used zip codes to link patients with the enrollment boundaries of Oregon public high schools, which were classified as either "AT group" or "non-AT group". We implemented an innovative microsimulation analysis to address the uncertainty of linkage between children and schools.
Our analysis included 64,115 and 84,968 eligible children with Medicaid and commercial insurance, respectively. Associated with high school AT services, Medicaid saved an average of $64 per patient during the study period, while commercial insurance payment rarely changed. AT services may reduce emergency visits for both insurance types but increase total visits for commercially insured patients.
Our study provides evidence for the differential impacts of AT services on medical payments and utilizations. The legislators should consider to allocate funds for high schools to directly employ ATs. This will encourage ATs to work to their highest ability to improve children's wellbeing while containing avoidable medical cost.
在高中增加运动训练师（AT）服务作为管理伤病和改善儿童健康的有效手段，已在全国引起广泛关注，但缺乏关于潜在医疗费用节省的证据。我们的研究旨在填补这一知识空白，并提供AT对医疗支付和医疗服务利用影响的证据，以为公共政策决策提供参考。
我们从2011 - 2014年俄勒冈州全支付方全索赔有限数据集中获取了14至18岁患者的医疗索赔信息。我们计算了AT执业范围内医疗索赔的支付方支付金额和医疗服务利用率。我们使用邮政编码将患者与俄勒冈州公立高中的招生范围联系起来，这些高中被分为“AT组”或“非AT组”。我们实施了一种创新的微观模拟分析，以解决儿童与学校之间联系的不确定性。
我们的分析分别包括64115名和84968名符合条件的医疗补助和商业保险儿童。与高中AT服务相关，在研究期间，医疗补助每位患者平均节省64美元，而商业保险支付几乎没有变化。AT服务可能会减少两种保险类型的急诊就诊次数，但会增加商业保险患者的总就诊次数。
我们的研究为AT服务对医疗支付和医疗服务利用的不同影响提供了证据。立法者应考虑为高中分配资金以直接雇佣AT。这将鼓励AT充分发挥其能力，在控制可避免的医疗成本的同时改善儿童的健康状况。
