Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park.
JAMA Netw Open. 2021 Mar 1;4(3):e211762. doi: 10.1001/jamanetworkopen.2021.1762.
Decreasing use of low-value care is a major goal for Medicare given the potential to decrease costs and harms. Compared with traditional fee-for-service Medicare (TM), Medicare Advantage (MA) is more strongly financially incentivized to decrease use of low-value care.
To compare use of low-value care among individuals enrolled in TM and those enrolled in MA overall and to examine trends in use of low-value care in both programs from 2006 to 2015.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed individuals enrolled in TM and MA using data from the 2006 to 2015 Medical Expenditure Panel Survey. To account for differences in characteristics between individuals enrolled in TM and those enrolled in MA, a propensity score-based approach was used. Data were analyzed from August 2020 through January 2021.
Being enrolled in MA or TM.
Binary measures of use were collected for 13 low-value services in 4 categories (ie, [1] cancer screening: cervical, colorectal, and prostate cancer screening in older adults; [2] antibiotic use: antibiotic for acute upper respiratory infection and antibiotic for influenza; [3] medication: anxiolytic, sedative, or hypnotic in an adult older than 65 years; benzodiazepine for depression; opioid for headache; opioid for back pain; and nonsteroidal anti-inflammatory drug [NSAID] for hypertension, heart failure, or chronic kidney disease; and [4] imaging: magnetic resonance imaging [MRI] or computed tomography [CT] for back pain, radiograph for back pain, and MRI or CT for headache) and 4 low-value composites corresponding to the categories (ie, cancer screening composite, antibiotic use composite, medication composite, and imaging composite).
Among 11 677 individuals enrolled in TM and 5164 individuals enrolled in MA, 9429 (56.0%) were women and the mean (SD) age was 74.5 (6.3) years. Of 13 low-value services and 4 low-value composites, statistically significant differences were found in 2 measures. For the low-value medication composite, 2054 of 11 636 eligible individuals enrolled in TM (adjusted mean, 17.6%; 95% CI, 16.8%-18.3%) received the care, and 981 of 5141 eligible individuals enrolled in MA (adjusted mean, 19.7%; 95% CI, 18.3%-21.2%) received the care, for a rate of use that was significantly higher among individuals enrolled in MA, by 2.2 percentage points (95% CI, 0.5-3.8 percentage points; P = .02). For the NSAID use for hypertension, heart failure, or kidney disease metric, 807 of 7832 individuals enrolled in TM (adjusted mean, 10.0%; 95% CI, 9.2%-10.8%) received the care, and 447 of 3566 individuals enrolled in MA (adjusted mean, 12.9%; 95% CI, 19.7%-27.1%) received the care, for a rate of use that was significantly higher among individuals enrolled in MA, by 2.9 percentage points (95% CI, 1.3-4.6 percentage points; P = .001). Overall, there were no decreases in use of low-value care in TM or MA over time.
This cross-sectional study found that use of low-value care was similarly prevalent in MA and TM, suggesting that MA enrollment was not associated with decreased provision of low-value care compared with TM.
鉴于降低成本和危害的潜力，减少低价值护理的使用是医疗保险的主要目标。与传统的按服务收费医疗保险（TM）相比，医疗保险优势（MA）在经济上更有动力减少低价值护理的使用。
比较整体纳入 TM 和 MA 的个体中低价值护理的使用情况，并检查这两个项目从 2006 年到 2015 年低价值护理使用的趋势。
设计、地点和参与者：这项横断面研究使用 2006 年至 2015 年医疗支出面板调查的数据，分析了纳入 TM 和 MA 的个体。为了说明纳入 TM 和 MA 的个体在特征上的差异，采用了基于倾向评分的方法。数据分析于 2020 年 8 月至 2021 年 1 月进行。
纳入 MA 或 TM。
在四个类别中（即[1]癌症筛查：老年人的宫颈癌、结直肠癌和前列腺癌筛查；[2]抗生素使用：急性上呼吸道感染和流感的抗生素；[3]药物：65 岁以上成年人的抗焦虑药、镇静剂或催眠药；用于抑郁症的苯二氮䓬类药物；用于头痛的阿片类药物；用于背痛的阿片类药物；用于高血压、心力衰竭或慢性肾病的非甾体抗炎药[NSAID]；和[4]影像学：背痛的磁共振成像[MRI]或计算机断层扫描[CT]、背痛的 X 线摄影、头痛的 MRI 或 CT），共收集了 13 种低价值服务和 4 种低价值组合的二进制使用情况，对应于上述四个类别（即癌症筛查组合、抗生素使用组合、药物组合和影像学组合）。
在纳入 TM 的 11677 人和纳入 MA 的 5164 人中，9429 人（56.0%）为女性，平均（SD）年龄为 74.5（6.3）岁。在 13 种低价值服务和 4 种低价值组合中，有 2 项测量值存在统计学显著差异。在低价值药物组合中，纳入 TM 的 11636 名符合条件的个体中有 2054 名（调整后平均值为 17.6%；95%CI，16.8%-18.3%）接受了该护理，纳入 MA 的 5141 名符合条件的个体中有 981 名（调整后平均值为 19.7%；95%CI，18.3%-21.2%）接受了该护理，接受 MA 护理的比例明显更高，高 2.2 个百分点（95%CI，0.5-3.8 个百分点；P=0.02）。在 NSAID 用于高血压、心力衰竭或肾脏病指标中，纳入 TM 的 7832 名个体中有 807 名（调整后平均值为 10.0%；95%CI，9.2%-10.8%）接受了该护理，纳入 MA 的 3566 名个体中有 447 名（调整后平均值为 12.9%；95%CI，19.7%-27.1%）接受了该护理，接受 MA 护理的比例明显更高，高 2.9 个百分点（95%CI，1.3-4.6 个百分点；P=0.001）。总体而言，在 TM 或 MA 中，低价值护理的使用并没有随着时间的推移而减少。
这项横断面研究发现，MA 和 TM 中低价值护理的使用同样普遍，这表明与 TM 相比，MA 的参保情况与低价值护理的提供减少无关。
