Skopec Laura, Zuckerman Stephen, Aarons Joshua, Wissoker Douglas, Huckfeldt Peter J, Feder Judith, Berenson Robert A, Dey Judith, Oliveira Iara
Laura Skopec (
Stephen Zuckerman is vice president for health policy, Urban Institute.
Health Aff (Millwood). 2020 Jun;39(6):1072-1079. doi: 10.1377/hlthaff.2019.01091.
Medicare covers home health benefits for homebound beneficiaries who need intermittent skilled care. While home health care can help prevent costlier institutional care, some studies have suggested that traditional Medicare beneficiaries may overuse home health care. This study compared home health use in Medicare Advantage and traditional Medicare, as well as within Medicare Advantage by beneficiary cost sharing, prior authorization requirement, and plan type. In 2016 Medicare Advantage enrollees were less likely to use home health care than traditional Medicare enrollees were, had 7.1 fewer days per home health spell, and were less likely to be admitted to the hospital during their spell. Among Medicare Advantage plans, those that imposed beneficiary cost sharing or prior authorization requirements had lower rates of home health use. Qualitative interviews suggested that Medicare Advantage payment and contracting approaches influenced home health care use. Therefore, changes in traditional Medicare home health payment policies implemented in 2020 may reduce these disparities in home health use and spell length.
医疗保险为需要间歇性专业护理的居家受益人提供居家健康福利。虽然居家医疗保健有助于预防成本更高的机构护理，但一些研究表明，传统医疗保险受益人可能过度使用居家医疗保健。本研究比较了医疗保险优势计划和传统医疗保险中居家医疗的使用情况，以及医疗保险优势计划中按受益人费用分摊、事先授权要求和计划类型划分的居家医疗使用情况。2016年，医疗保险优势计划参保者使用居家医疗保健的可能性低于传统医疗保险参保者，每次居家医疗疗程的天数少7.1天，且在疗程期间住院的可能性也较小。在医疗保险优势计划中，那些实施受益人费用分摊或事先授权要求的计划，其居家医疗使用率较低。定性访谈表明，医疗保险优势计划的支付和签约方式影响了居家医疗保健的使用。因此，2020年实施的传统医疗保险居家医疗支付政策的变化可能会减少居家医疗使用和疗程时长方面的这些差异。
