Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD.
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
J Arthroplasty. 2020 Oct;35(10):2791-2797. doi: 10.1016/j.arth.2020.05.060. Epub 2020 May 28.
Maryland possesses a unique, population-based alternative payment model named Global Budget Revenue (GBR). This study evaluated the effects of GBR on demographics and outcomes for patients who underwent primary total hip arthroplasty (THA) by comparing Maryland to the United States (U.S.).
We identified primary THA patients in the Maryland State Inpatient Database (n = 35,925) and the National Inpatient Sample (n = 2,155,703) between 2011 and 2016 utilizing International Classification of Diseases 9 and 10 diagnosis codes. Qualitative analysis was used to report trends. Multiple regressions were used for difference-in-difference (DID) analyses to compare Maryland to the U.S. between pre-GBR (2011-2013) and post-GBR (2014-2016) periods.
After GBR implementation, there were proportionally more patients who were obese (Maryland: +5.1% vs U.S.: +3.0%), used Medicare (+1.6% vs +0.7%), used Medicaid (+2.4% vs +1.3%) while less used private insurance (-4.2% vs -1.8%) (all P < .001). There were proportionally less home health care patients in Maryland, but more in the U.S. (-3.5% vs +1.6%; both P < .001). The mean costs decreased for both cohorts (-$1780.80 vs -$209.40; both P < .001). The DID found Maryland saw more Medicaid and less private insurance patients under GBR (both P ≤ .001). Maryland saw more obese patients than would be expected (P = .001). The DID also found decreased costs for patients under GBR (P < .001 for both).
Maryland has benefitted from GBR with decreased cost and an increase in Medicaid patients. Maryland may provide a viable model for future healthcare policies that incorporate global budgets.
马里兰州拥有一种独特的、基于人群的替代支付模式，名为全球预算收入（GBR）。本研究通过将马里兰州与美国（U.S.）进行比较，评估了 GBR 对接受初次全髋关节置换术（THA）的患者的人口统计学和结果的影响。
我们利用国际疾病分类第 9 版和第 10 版诊断代码，在 2011 年至 2016 年期间，从马里兰州住院患者数据库（n=35925）和全国住院患者样本（n=2155703）中确定了初次 THA 患者。采用定性分析报告趋势。采用双重差分（DID）分析比较 GBR 实施前后（2011-2013 年和 2014-2016 年）马里兰州与美国之间的差异。
在 GBR 实施后，肥胖患者的比例（马里兰州：+5.1% vs. 美国：+3.0%）、使用医疗保险（+1.6% vs. +0.7%）、使用医疗补助（+2.4% vs. +1.3%）的比例增加，而私人保险的使用比例（-4.2% vs. -1.8%）减少（均 P<.001）。马里兰州的家庭保健患者比例减少，但美国的患者比例增加（-3.5% vs. +1.6%；均 P<.001）。两个队列的平均费用都有所下降（-$1780.80 vs. -$209.40；均 P<.001）。DID 发现，在 GBR 下，马里兰州有更多的医疗补助和更少的私人保险患者（均 P≤.001）。马里兰州的肥胖患者比预期的要多（P=.001）。DID 还发现，GBR 下的患者成本降低（均 P<.001）。
马里兰州从 GBR 中受益，成本降低，医疗补助患者增加。马里兰州可能为未来纳入全球预算的医疗保健政策提供了一种可行的模式。
