美国残疾成年人预防性服务的使用情况及潜在可避免的住院情况：传统医疗保险和商业保险的纵向分析
Use of preventive service and potentially preventable hospitalization among American adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance.
作者信息
Mahmoudi Elham, Lin Paul, Rubenstein Dana, Guetterman Timothy, Leggett Amanda, Possin Katherine L, Kamdar Neil
机构信息
Department of Family Medicine, Michigan Medicine, University of Michigan, USA.
Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
出版信息
Prev Med Rep. 2024 Feb 23;40:102663. doi: 10.1016/j.pmedr.2024.102663. eCollection 2024 Apr.
OBJECTIVE
Examine the association between traditional Medicare (TM) vs. commercial insurance and the use of preventive care and potentially preventable hospitalization (PPH) among adults (18+) with disability [cerebral palsy/spina bifida (CP/SB); multiple sclerosis (MS); traumatic spinal cord injury (TSCI)] in the United States.
METHODS
Using 2008-2016 Medicare and commercial claims data, we compared adults with the same disability enrolled in TM vs. commercial insurance [Medicare: n = 21,599 (CP/SB); n = 7,605 (MS); n = 4,802 (TSCI); commercial: n = 11,306 (CP/SB); n = 6,254 (MS); n = 5,265 (TSCI)]. We applied generalized estimating equations to address repeated measures, comparing cases with controls. All models were adjusted for age, sex, race/ethnicity, and comorbid conditions.
RESULTS
Compared with commercial insurance, enrolling in TM reduced the odds of using preventive services. For example, adjusted odds ratios (OR) of annual wellness visits in TM vs. commercial insurance were 0.31 (95% confidence interval (CI): 0.28-0.34), 0.32 (95% CI: 0.28-0.37), and 0.19 (95% CI: 0.17-0.22) among adults with CP/SB, TSCI, and MS, respectively. Furthermore, PPH risks were higher in TM vs. commercial insurance. ORs of PPH in TM vs. commercial insurance were 1.50 (95% CI: 1.18-1.89), 1.83 (95% CI: 1.40-2.41), and 2.32 (95% CI: 1.66-3.22) among adults with CP/SB, TSCI, and MS, respectively. Moreover, dual-eligible adults had higher odds of PPH compared with non-dual-eligible adults [CP/SB: OR = 1.47 (95% CI: 1.25-1.72); TSCI: OR = 1.61 (95% CI: 1.35-1.92), and MS: OR = 1.80 (95% CI: 1.55-2.10)].
CONCLUSIONS
TM, relative to commercial insurance, was associated with lower receipt of preventive care and higher PPH risk among adults with disability.
目的
研究美国传统医疗保险（TM）与商业保险之间的差异，以及18岁及以上残疾成年人（患有脑瘫/脊柱裂（CP/SB）、多发性硬化症（MS）、创伤性脊髓损伤（TSCI））的预防保健服务使用情况和潜在可预防住院（PPH）情况。
方法
利用2008 - 2016年医疗保险和商业保险理赔数据，我们比较了参加TM和商业保险的相同残疾成年人[医疗保险：n = 21,599（CP/SB）；n = 7,605（MS）；n = 4,802（TSCI）；商业保险：n = 11,306（CP/SB）；n = 6,254（MS）；n = 5,265（TSCI）]。我们应用广义估计方程来处理重复测量问题，将病例与对照进行比较。所有模型均根据年龄、性别、种族/民族和合并症进行了调整。
结果
与商业保险相比，参加TM会降低使用预防服务的几率。例如，在患有CP/SB、TSCI和MS的成年人中，TM与商业保险相比，年度健康检查的调整优势比（OR）分别为0.31（95%置信区间（CI）：0.28 - 0.34）、0.32（95%CI：0.28 - 0.37）和0.19（95%CI：0.17 - 0.22）。此外，TM组的PPH风险高于商业保险组。在患有CP/SB、TSCI和MS的成年人中，TM与商业保险相比，PPH的OR分别为1.50（95%CI：1.18 - 1.89）、1.83（95%CI：1.40 - 2.41）和2.32（95%CI：1.66 - 3.22）。此外，与非双重资格成年人相比，双重资格成年人发生PPH的几率更高[CP/SB：OR = 1.47（95%CI：1.25 - 1.72）；TSCI：OR = 1.61（95%CI：1.35 - 1.92），MS：OR = 1.80（95%CI：1.55 - 2.10）]。
结论
相对于商业保险，TM与残疾成年人预防保健服务的接受率较低以及PPH风险较高有关。
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