Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT.
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Ann Emerg Med. 2024 Sep;84(3):285-294. doi: 10.1016/j.annemergmed.2024.04.023. Epub 2024 Jun 12.
We sought to quantify differences in total and out-of-pocket health care costs associated with treat-and-release emergency department (ED) visits among older adults with traditional Medicare and Medicare Advantage.
We conducted a repeated cross-sectional analysis of treat-and-release ED visits using 2015 to 2020 data from the Medicare Current Beneficiary Survey. We measured total and out-of-pocket health care spending during 3 time periods: the 30 days prior to the ED visit, the treat-and-release ED visit itself, and the 30 days after the ED visit. Stratified by traditional Medicare or Medicare Advantage status, we determined median total costs and the proportion of costs that were out-of-pocket.
Among the 5,011 ED visits by those enrolled in traditional Medicare, the weighted median total (and % out-of-pocket) costs were $881.95 (13.3%) for the 30 days prior to the ED visit, $419.70 (10.1%) for the ED visit, and $809.00 (13.8%) for the 30 days after the ED visit. For the 2,595 ED visits by those enrolled in Medicare Advantage, the weighted median total (and % out-of-pocket) costs were $484.92 (24.0%) for the 30 days prior to the ED visit, $216.66 (21.9%) for the ED visit, and $439.13 (22.4%) for the 30 days after the ED visit.
Older adults insured by Medicare Advantage incur lower total health care costs and face similar overall out-of-pocket expenses in the time period surrounding emergency care. However, a higher proportion of expenses are out-of-pocket compared with those insured by traditional Medicare, providing evidence of greater cost sharing for Medicare Advantage plan enrollees.
我们旨在量化传统 Medicare 和 Medicare Advantage 参保老年人因急诊就诊而产生的总医疗费用和自付费用的差异。
我们利用 2015 年至 2020 年 Medicare 现受益人调查数据，对急诊就诊的治疗后离院患者进行了重复横断面分析。我们在三个时间段测量了总医疗费用和自付费用：就诊前 30 天、急诊就诊期间和急诊就诊后 30 天。我们按传统 Medicare 或 Medicare Advantage 参保情况进行分层，确定了总费用中位数和自付费用比例。
在 5011 例传统 Medicare 参保者的急诊就诊中，就诊前 30 天的加权中位数总（和自付）费用为 881.95 美元（13.3%），急诊就诊期间为 419.70 美元（10.1%），急诊就诊后 30 天为 809.00 美元（13.8%）。在 2595 例 Medicare Advantage 参保者的急诊就诊中，就诊前 30 天的加权中位数总（和自付）费用为 484.92 美元（24.0%），急诊就诊期间为 216.66 美元（21.9%），急诊就诊后 30 天为 439.13 美元（22.4%）。
在急诊护理期间，Medicare Advantage 参保的老年人的总医疗费用较低，面临的总体自付费用相似。然而，与传统 Medicare 参保者相比，自付费用的比例更高，这表明 Medicare Advantage 计划参保者的费用分担更多。
