Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
RTI International, Research Triangle Park, North Carolina.
JAMA Netw Open. 2020 Mar 2;3(3):e201809. doi: 10.1001/jamanetworkopen.2020.1809.
Compared with traditional Medicare (TM) fee-for-service plans, Medicare Advantage (MA) plans may provide more-efficient care for beneficiaries with Alzheimer disease and related dementias (ADRD) without compromising care quality.
To determine differences in health care utilization, care satisfaction, and health status for MA and TM beneficiaries with and without ADRD.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study was conducted of MA and TM beneficiaries with and without ADRD from all publicly available years of the Medicare Current Beneficiary Survey between 2010 and 2016. To address advantageous selection into MA plans, county-level MA enrollment rate was used as an instrument. Data were analyzed between July 2019 and December 2019.
Enrollment in MA.
Self-reported health care utilization, care satisfaction, and health status.
The sample included 47 100 Medicare beneficiaries (25 900 women [54.9%]; mean [SD] age, 72.2 [11.4] years). Compared with TM beneficiaries with ADRD, MA beneficiaries with ADRD had lower utilization across the board, including a mean of -22.3 medical practitioner visits (95% CI, -24.9 to -19.8 medical practitioner visits), -2.3 outpatient hospital visits (95% CI, -3.6 to -1.1 outpatient hospital visits), -0.2 inpatient hospital admissions (95% CI, -0.3 to -0.1 inpatient hospital admissions), and -0.1 long-term care facility stays (95% CI, -0.2 to -0.1 long-term care facility stays). A similar trend was observed among beneficiaries without ADRD, but the difference was greater between MA and TM beneficiaries with ADRD than between MA and TM beneficiaries without ADRD (mean, -15.0 medical practitioner visits [95% CI, -18.7 to -11.3 medical practitioner visits], -1.7 outpatient hospital visits [95% CI, -3.0 to -0.3 outpatient hospital visits], and -0.1 inpatient hospital admissions [95% CI, -1.0 to 0.0 inpatient hospital admissions]). Overall, no or negligible differences were detected in care satisfaction and health status between MA and TM beneficiaries with and without ADRD.
Compared with TM beneficiaries, MA beneficiaries had lower health care utilization without compromising care satisfaction and health status. This difference was more pronounced among beneficiaries with ADRD. These findings suggest that MA plans may be delivering health care more efficiently than TM, especially for beneficiaries with ADRD.
重要性：与传统的医疗保险（TM）按服务收费计划相比，医疗保险优势（MA）计划可能为患有阿尔茨海默病和相关痴呆症（ADRD）的受益人提供更有效的护理，而不会降低护理质量。
目的：确定 ADDR 患者和非 ADDR 患者中 MA 和 TM 受益人的医疗保健利用、护理满意度和健康状况的差异。
设计、环境和参与者：这项队列研究对 2010 年至 2016 年所有公开可用的医疗保险当前受益人大调查年中 ADDR 患者和非 ADDR 患者的 MA 和 TM 受益人的数据进行了分析。为了解决选择 MA 计划的优势，使用县级 MA 入保率作为工具。数据分析于 2019 年 7 月至 2019 年 12 月进行。
暴露：入保 MA。
主要结果和措施：自我报告的医疗保健利用率、护理满意度和健康状况。
结果：样本包括 47100 名医疗保险受益人（25900 名女性[54.9%]；平均[标准差]年龄 72.2[11.4]岁）。与 TM 计划中的 ADRD 患者相比，MA 计划中的 ADRD 患者的利用率普遍较低，包括平均减少 22.3 次就诊（95%CI，-24.9 至-19.8 次就诊），减少 2.3 次门诊医院就诊（95%CI，-3.6 至-1.1 次门诊医院就诊），减少 0.2 次住院就诊（95%CI，-0.3 至-0.1 次住院就诊），减少 0.1 次长期护理机构入住（95%CI，-0.2 至-0.1 次长期护理机构入住）。在没有 ADRD 的受益人中也观察到了类似的趋势，但 MA 计划和 TM 计划中 ADRD 患者之间的差异大于 MA 计划和 TM 计划中没有 ADRD 的患者之间的差异（平均减少 15.0 次就诊[95%CI，-18.7 至-11.3 次就诊]，减少 1.7 次门诊就诊[95%CI，-3.0 至-0.3 次门诊就诊]，以及减少 0.1 次住院就诊[95%CI，-1.0 至 0.0 次住院就诊]）。总体而言，在有和没有 ADRD 的 MA 和 TM 受益人的护理满意度和健康状况方面，没有或几乎没有差异。
结论和相关性：与 TM 受益相比，MA 受益人的医疗保健利用率较低，但不会降低护理满意度和健康状况。这种差异在患有 ADRD 的患者中更为明显。这些发现表明，MA 计划可能比 TM 计划更有效地提供医疗保健，尤其是对患有 ADRD 的患者。
