Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
JAMA Health Forum. 2022 Dec 2;3(12):e224475. doi: 10.1001/jamahealthforum.2022.4475.
After decades of rapid increase, Medicare per-beneficiary spending growth was historically low in the period leading up to the passage of the Affordable Care Act. In the years immediately following the legislation, Medicare expenditure growth slowed even further.
To evaluate factors contributing to the slowdown in Medicare per-beneficiary spending growth.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, expected spending growth for 2012 to 2015 and 2016 to 2018 was predicted holding payment rates and population characteristics constant. By contrasting predicted and actual spending growth during these periods, the contribution of population vs payment factors to the Medicare spending slowdown was determined. Analyses included all Medicare fee-for-service beneficiaries aged 65 years and older, ranging from 30 to 35 million beneficiaries annually between 2007 and 2018. Data analyses were conducted from January 2018 to August 2018 and updated with new data in June 2021.
The main outcome included annual growth in total per-beneficiary spending. The roles of payment rate changes and differences in the Medicare population over time were considered, including demographic characteristics and numbers of chronic conditions.
Between 2008 to 2011 and 2012 to 2015, the adjusted annual Medicare Parts A and B per-beneficiary spending growth rate declined from 3.3% to -0.1%. From 2016 to 2018, the mean annual Medicare spending growth rate rose relative to the previous period but remained lower than in the baseline period at 1.7% per year. This slowdown extended across all sectors within Parts A and B, except for physician-administered drugs offered under Part B. Changes in payment rates (including sequestration measures) and beneficiary characteristics explained 44% of the difference in overall per-beneficiary spending growth between 2007 to 2011 and 2012 to 2015, and 63% between 2007 to 2011 and 2016 to 2018.
In this cross-sectional study of trends in spending growth per Medicare beneficiary aged 65 years or older, results suggested that Medicare payment policy, including sector-specific payment rate changes and sequestration, will be a critical determinant of whether the Medicare spending growth slowdown persists.
在平价医疗法案通过之前的几十年里，医疗保险的人均支出增长率一直呈历史低位。在该立法通过后的几年里，医疗保险支出的增长进一步放缓。
评估导致医疗保险人均支出增长放缓的因素。
设计、环境和参与者：在这项横断面研究中，假设支付率和人口特征保持不变，预测 2012 年至 2015 年和 2016 年至 2018 年的预期支出增长。通过对比这些时期的预测和实际支出增长，确定人口因素与支付因素对医疗保险支出放缓的贡献。分析包括所有年龄在 65 岁及以上的医疗保险按服务付费受益人的数据，2007 年至 2018 年期间每年的受益人数在 3000 万至 3500 万之间。数据分析于 2018 年 1 月至 2018 年 8 月进行，并于 2021 年 6 月进行了更新。
主要结果包括每个受益人的年度总支出增长。考虑了支付率变化和随时间推移的医疗保险人群的差异，包括人口特征和慢性病数量。
2008 年至 2011 年和 2012 年至 2015 年期间，调整后的医疗保险 A 部分和 B 部分每年人均支出增长率从 3.3%降至-0.1%。2016 年至 2018 年，医疗保险支出的年平均增长率与前一时期相比有所上升，但仍低于基线时期的 1.7%。这种放缓扩展到 A 部分和 B 部分的所有部门，除了 B 部分提供的医生管理药物。支付率变化（包括封存措施）和受益人的特征解释了 2007 年至 2011 年和 2012 年至 2015 年期间医疗保险人均支出增长总体差异的 44%，以及 2007 年至 2011 年和 2016 年至 2018 年期间的 63%。
在这项针对 65 岁及以上老年人的医疗保险受益人均支出增长趋势的横断面研究中，结果表明，医疗保险支付政策，包括部门特定的支付率变化和封存，将是决定医疗保险支出放缓是否持续的关键决定因素。
