RAND Corporation 1200 South Hayes Street Arlington, Virginia, 22202, USA.
Center for Clinical Informatics and Improvement Research, Department of Medicine University of California, San Francisco 3333 California St, Suite 265, San Francisco, CA, 94118, USA.
Healthc (Amst). 2020 Dec;8(4):100490. doi: 10.1016/j.hjdsi.2020.100490. Epub 2020 Oct 28.
To describe the association between longitudinal enrollment in Medicare Advantage (MA) and utilization, access, quality of care, and health outcomes for beneficiaries with complex health needs.
DATA SOURCES/STUDY SETTING: Beneficiary characteristics, enrollment, and outcomes data from the 2004-2016 waves of the Health and Retirement Study (HRS).
Using the HRS panel structure, we identified beneficiaries consistently reporting high needs as well as enrollment in MA versus traditional Medicare (TM). We first evaluated a robust set of beneficiary characteristics to identify those that distinguish beneficiaries who consistently enrolled in MA versus TM. We then described adjusted differences in outcomes between high-needs beneficiaries who consistently enrolled in MA versus TM.
Among high-needs beneficiaries, there was a modest amount of favorable selection into MA based on health. Controlling for several characteristics, MA enrollees used less care (with a 6.6 percentage point (pp) lower probability of hospitalization, 4.7 fewer physician visits, and a 5.1 pp lower probability of using home health care), had a 4.1 pp greater probability of being unable to afford their care, and had a 5.7 pp lower probability of reporting that they were very satisfied with their care. Compared to associations between MA and outcomes for high-needs beneficiaries, for non-high-needs beneficiaries MA enrollment was associated with smaller decreases in utilization and no statistically significant difference in the inability to afford care.
Our descriptive findings raise the possibility that high-needs beneficiaries may experience unique challenges in MA compared to their non-high-needs counterparts.
描述在医疗保险优势计划（MA）中进行纵向参保与有复杂健康需求的受益人的利用、获取、护理质量和健康结果之间的关联。
数据来源/研究环境：来自健康与退休研究（HRS）2004-2016 年各波次的受益人的特征、参保和结果数据。
利用 HRS 面板结构，我们确定了持续报告高需求的受益人和 MA 与传统医疗保险（TM）的参保者。我们首先评估了一组稳健的受益人性别特征，以确定那些能够区分持续选择 MA 与 TM 的受益人的特征。然后，我们描述了在持续选择 MA 与 TM 的高需求受益人中，调整后的结果差异。
在高需求受益人中，根据健康状况，MA 参保者的选择存在适度的有利倾向。在控制了几个特征后，MA 参保者的护理利用率较低（住院的可能性降低 6.6 个百分点，就诊次数减少 4.7 次，使用家庭保健护理的可能性降低 5.1 个百分点），无法负担护理费用的可能性增加 4.1 个百分点，并且对护理非常满意的可能性降低 5.7 个百分点。与 MA 与高需求受益人的结果之间的关联相比，对于非高需求受益人的 MA 参保与利用率降低幅度较小，并且在无法负担护理费用方面没有统计学上的显著差异。
我们的描述性发现提出了这样一种可能性，即与非高需求受益相比，高需求受益在 MA 中可能面临独特的挑战。
