Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Popul Health Manag. 2022 Aug;25(4):501-508. doi: 10.1089/pop.2021.0334. Epub 2022 May 9.
Hospitals have demonstrated the benefits of both voluntary and mandatory bundled payments for joint replacement surgery. However, given generalizability and disparities concerns, it is critical to understand the availability of care through bundled payments to historically marginalized groups, such as racial and ethnic minorities and individuals with lower socioeconomic status (SES). This cross-sectional analysis of 3880 US communities evaluated the relationship between the proportion of Black and Hispanic individuals (minority share) or Medicare/Medicaid dual-eligible individuals (low SES share) and community-level participation in Bundled Payments for Care Improvement initiative (BPCI) (being a BPCI community) and Comprehensive Care for Joint Replacement (CJR) model (being a CJR community). An increase from the lowest to highest quartile of minority share was not associated with differences in the probability of being a BPCI community (3.5 percentage point [pp] difference, 95% confidence interval [CI] -1.2% to 8.3%, = 0.15), but was associated with a 16.1 pp higher probability of being a CJR community (95% CI 10.3% to 22.0%, < 0.0001). An increase from the lowest to highest quartile of low SES share was associated with a 6.0 pp lower probability of being a BPCI community (95% CI -10.9% to -1.2%, = 0.02) and 19.0 pp lower probability of being a CJR community (95% CI -24.9% to -13.0%, < 0.0001). These findings highlight that the greater the proportion of lower SES individuals in a community, the lower the likelihood that its hospitals participated in either voluntary or mandatory bundled payments. Policymakers should consider community socioeconomic characteristics when designing participation mechanisms for future bundled payment programs.
医院已经证明了自愿和强制性捆绑支付在关节置换手术方面的好处。然而，鉴于推广性和差异问题，了解历史上处于边缘地位的群体（如少数民族和社会经济地位较低的个人）获得捆绑支付的护理情况至关重要。本项针对 3880 个美国社区的横断面分析评估了黑人和西班牙裔个体（少数群体份额）或医疗保险/医疗补助双重合格个体（低 SES 份额）在社区层面参与改善护理捆绑支付倡议（BPCI）（成为 BPCI 社区）和全面关节置换护理（CJR）模型（成为 CJR 社区）的比例之间的关系。少数群体份额从最低到最高四分位数的增加与成为 BPCI 社区的可能性没有差异（3.5 个百分点[pp]差异，95%置信区间[CI]-1.2%至 8.3%，=0.15），但与成为 CJR 社区的可能性增加了 16.1 pp（95% CI 10.3%至 22.0%，<0.0001）。低 SES 份额从最低到最高四分位数的增加与成为 BPCI 社区的可能性降低了 6.0 pp（95% CI-10.9%至-1.2%，=0.02）和成为 CJR 社区的可能性降低了 19.0 pp（95% CI-24.9%至-13.0%，<0.0001）相关。这些发现强调，社区中 SES 较低个体的比例越大，其医院参与自愿或强制性捆绑支付的可能性就越低。政策制定者在为未来捆绑支付计划设计参与机制时，应考虑社区的社会经济特征。
