Rajender Agarwal (
John Connolly is a medical student in the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, in Philadelphia, Pennsylvania.
Health Aff (Millwood). 2021 Jun;40(6):937-944. doi: 10.1377/hlthaff.2020.02149.
Medicare Advantage enrollment has almost doubled since 2010 and now accounts for more than a third of all Medicare beneficiaries. We performed a systematic review to compare Medicare Advantage and traditional Medicare on key metrics. Evidence from forty-eight studies showed that in most or all comparisons, Medicare Advantage was associated with more preventive care visits, fewer hospital admissions and emergency department visits, shorter hospital and skilled nursing facility lengths-of-stay, and lower health care spending. Medicare Advantage outperformed traditional Medicare in most studies comparing quality-of-care metrics. However, the evidence on patient experience, readmission rates, mortality, and racial/ethnic disparities did not show a trend of better performance in Medicare Advantage. Evidence to date might not fully account for selection bias, unobserved differences in social determinants of health, or risk adjustment challenges, in part because of differences in data quality that limit the comparability of outcomes between Medicare Advantage and traditional Medicare. With Medicare Advantage plans expected to grow in popularity, policy makers should support policies to improve data completeness and comparability, and health plans should focus on improving patient experience.
自 2010 年以来，医疗保险优势计划的参保人数几乎翻了一番，现在占所有医疗保险受益人的三分之一以上。我们进行了一项系统评价，比较了医疗保险优势计划和传统医疗保险在关键指标上的差异。来自 48 项研究的证据表明，在大多数或所有比较中，医疗保险优势计划与更多的预防保健就诊、更少的住院和急诊就诊、更短的住院和熟练护理机构住院时间以及更低的医疗保健支出相关。在大多数比较医疗质量指标的研究中，医疗保险优势计划的表现优于传统医疗保险。然而，关于患者体验、再入院率、死亡率和种族/民族差异的证据并没有显示医疗保险优势计划在表现上有更好的趋势。迄今为止的证据可能没有充分考虑选择偏差、健康的社会决定因素的未观察到差异，或者风险调整方面的挑战，部分原因是数据质量的差异限制了医疗保险优势计划和传统医疗保险之间结果的可比性。随着医疗保险优势计划的受欢迎程度预计将增加，政策制定者应支持改善数据完整性和可比性的政策，而医疗保健计划应专注于改善患者体验。
