医疗保险和医疗补助双重资格人群接受阿尔茨海默病诊断评估机会的差异：建模研究。
Disparities in Access to Diagnostic Evaluation for Alzheimer's Disease in Individuals Dually Eligible for Medicare and Medicaid: A Modeling Study.
机构信息
The USC Brain Health Observatory, University of Southern California, Los Angeles, CA, USA.
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
出版信息
J Alzheimers Dis. 2024;98(4):1403-1414. doi: 10.3233/JAD-231134.
BACKGROUND
Individuals dually eligible for Medicare and Medicaid (duals) may face greater obstacles to access to disease-modifying Alzheimer's treatments in spite of their higher disease burden, because of clinicians' reluctance to accept Medicaid and the so-called "lesser of" policy, under which Medicaid may pay providers lower rates.
OBJECTIVE
To project differential wait times for duals compared to Medicare-only beneficiaries by state.
METHODS
We used State Medicaid payment policy and Medicare enrollment data and a Markov model to predict differential wait times for duals and non-duals from 2023 to 2050. We estimated available diagnostic appointments by state for both groups based on reluctance of clinicians to accept Medicaid and the "lesser of" policy for each year.
RESULTS
We estimate overall average wait times of almost two years (22.9 months) but almost three times as long for duals (59.8 months) than non-duals (20.7 months) because of higher disease burden. The effects of Medicaid payment policy would increase average wait times for duals to 89 months with 20 states having wait times of 99 months or more, which would effectively deprive duals of access.
CONCLUSIONS
The added average wait times in many states would effectively deprive duals from access to treatment and translate into avoidable disease progression and mortality. Policy interventions to reduce financial and nonfinancial obstacles are dearly needed to avoid deepening disparities. Examples are coverage arrangements that integrate Medicare and Medicaid coverage, covering the co-payment for physician services in full, and stricter network adequacy requirements for Medicaid Managed Care plans.
背景
尽管患有更严重的疾病，但同时符合联邦医疗保险（Medicare）和医疗补助计划（Medicaid）双重资格的个人（双重资格者）可能会因为临床医生不愿意接受 Medicaid 和所谓的“较低者”政策而面临更大的获得疾病修饰性阿尔茨海默病治疗的障碍，根据该政策， Medicaid 可能会向提供者支付较低的费用。
目的
按州预测双重资格者与仅符合 Medicare 资格者的等待时间差异。
方法
我们使用州 Medicaid 支付政策和 Medicare 参保数据以及马尔可夫模型，预测 2023 年至 2050 年双重资格者和非双重资格者的等待时间差异。我们根据临床医生对 Medicaid 的接受程度以及每年 Medicaid 的“较低者”政策，估计了这两个群体在每个州的可用诊断预约数量。
结果
我们估计总体平均等待时间将近两年（22.9 个月），但双重资格者的等待时间几乎是三倍（59.8 个月），而非双重资格者的等待时间为 20.7 个月，这是因为双重资格者的疾病负担更高。 Medicaid 支付政策的影响将使双重资格者的平均等待时间增加到 89 个月，其中 20 个州的等待时间将达到 99 个月或更长，这将使双重资格者实际上无法获得治疗。
结论
许多州增加的平均等待时间将使双重资格者实际上无法获得治疗，并导致可避免的疾病进展和死亡。迫切需要采取政策干预措施来减少财务和非财务障碍，以避免差距进一步扩大。例如，涵盖 Medicare 和 Medicaid 覆盖范围的覆盖安排、全额支付医生服务的自付额以及对 Medicaid 管理式医疗计划更严格的网络充足性要求。
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