Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA.
Health Serv Res. 2023 Feb;58(1):128-139. doi: 10.1111/1475-6773.14019. Epub 2022 Jul 14.
To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65.
Health and Retirement Study survey data (1998-2018).
We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. A regression discontinuity design compared the self-reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility.
Not applicable.
A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage-point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage-point decrease (p = 0.002) in the probability of any care receipt.
Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.
评估老年人在 65 岁参加医疗保险后家庭和朋友护理的强度是否发生变化。
健康与退休研究调查数据（1998-2018 年）。
我们比较了因中风、心脏手术或关节手术住院的患者接受的非正式护理，并将其分为倾向评分加权的 Medicare 资格前和后队列。回归不连续设计比较了 Medicare 资格时自我报告的任何护理接受可能性、总体非正式护理每周小时数和非正式护理强度（接受任何护理的小时数）。
不适用。
共纳入 2270 人；1674 例（73.7%）中风、240 例（10.6%）心脏手术和 356 例（15.7%）关节手术患者。接受护理的平均（SD）时间为 20.0（42.1）周。在 1214 名（53.5%）接受非正式护理的患者中，平均（SD）护理接受时间为 37.4（51.7）周。中风、心脏手术和关节手术患者的平均（SD）每周接受护理时间分别为 23.4（45.5）、13.9（35.8）和 7.8（21.6）。医疗保险资格的开始与中风患者接受非正式护理的可能性降低了 13.6 个百分点（p=0.003），但在其他急性护理队列中没有。男性接受任何护理的可能性降低了 16.8 个百分点（p=0.002）。
医疗保险覆盖与中风患者家庭和朋友护理使用的大幅减少有关。鉴于医疗保险已知会扩大急性后护理的使用，非正式护理可能会替代而不是补充恢复性护理。医疗保险覆盖对非正式护理的观察到的溢出效应对患者功能和护理人员负担有影响，应在改变专业康复护理强度的基于事件的报销模型中加以考虑。
