Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
Department of Population Health, New York University Langone School of Medicine, New York, New York, USA.
Health Serv Res. 2021 Jun;56(3):528-539. doi: 10.1111/1475-6773.13650. Epub 2021 Mar 28.
To assess changes in physicians' provision of care to duals (low-income individuals with Medicare and Medicaid) in response to a policy that required Medicaid to fully pay Medicare's cost sharing for office visits with these patients. This policy-a provision of the Affordable Care Act-effectively increased payments for office visits with duals by 0%-20%, depending on the state, in 2013 and 2014.
Fee-for-service claims for a 5% random sample of Medicare beneficiaries in 2010-2016.
We conducted a difference-in-differences analysis to compare changes in office visits among Qualified Medicare Beneficiaries (QMBs)-the largest subpopulation of duals for whom payment rates were affected by this policy-to changes among other low-income Medicare beneficiaries for whom payment rates were unaffected (pooled across all states). Next, we conducted a triple-differences analysis that compared changes between QMBs and other low-income beneficiaries in 33 states with payment rate increases of approximately 20% to analogous changes in 14 states without payment increases.
The study included administrative Medicare enrollment and claims data for QMBs and a comparison group of other low-income Medicare beneficiaries (1 914 073 beneficiary-years from 2010 to 2016).
Nationally, we did not find a differential increase in office visits among QMBs versus other low-income beneficiaries that coincided with this payment change. In the triple-differences analysis, we did not observe a greater increase in visits among QMBs vs other low-income beneficiaries in states where the policy resulted in large (approximately 20%) increases in payment rates vs states where payment rates were unaffected (triple-differences estimate: -0.12 annual visits, 95% CI: -0.28, 0.04; P = 0.15).
Physicians' provision of care to low-income Medicare beneficiaries may not be responsive to short-run payment changes.
评估在一项要求医疗补助全额支付这些患者看诊的医疗保险共付额的政策出台后，医生为双重保险患者（医疗保险和医疗补助的低收入个人）提供的护理服务的变化情况。该政策是平价医疗法案的一项规定，2013 年和 2014 年，根据各州的不同，该政策将双重保险患者看诊的支付额增加了 0%到 20%。
2010-2016 年医疗保险受益人的 5%随机抽样的按服务收费索赔。
我们采用双重差分分析，比较符合条件的医疗保险受益人（双重保险中受益最大的人群，他们的支付率受该政策影响）与其他不受支付率影响的低收入医疗保险受益人（所有州汇总）的看诊次数变化。接下来，我们进行了三重差分分析，比较了在支付率增加约 20%的 33 个州中符合条件的医疗保险受益人和其他低收入受益人的变化情况，以及在没有支付增加的 14 个州的类似变化情况。
该研究包括符合条件的医疗保险受益人和其他低收入医疗保险受益人的医疗保险登记和索赔数据（2010 年至 2016 年，共 1914073 个受益年度）。
全国范围内，我们没有发现符合条件的医疗保险受益人与其他低收入受益人的看诊次数出现与此次支付变化相一致的差异增加。在三重差分分析中，我们没有观察到在政策导致支付率大幅增加（约 20%）的州，符合条件的医疗保险受益人与其他低收入受益人的就诊次数增加更多，而在支付率未受影响的州则没有（三重差分估计：-0.12 次就诊，95%CI：-0.28，0.04；P=0.15）。
医生为低收入医疗保险受益人的护理服务提供情况可能不会对短期支付变化做出反应。
