Roberts Anthony I, Santostefano Christopher M, Chen Zihan, McGarry Brian E, White Elizabeth M, Resnik Linda J, Geng Fangli, Grabowski David C, Rahman Momotazur
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI 02903, United States.
Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY 14642, United States.
Health Aff Sch. 2025 Mar 18;3(4):qxaf056. doi: 10.1093/haschl/qxaf056. eCollection 2025 Apr.
Medicare beneficiaries face significant health risks and care disruptions during public health emergencies, but little is known about how care patterns evolved throughout the COVID-19 pandemic or differed between traditional Medicare (TM) and Medicare Advantage (MA).
Using Medicare claims data for over 20 million hospital discharges during 2018-2022, we examined trends in hospital length of stay, discharge disposition, and mortality among beneficiaries with 5 major comorbidities (dementia, diabetes, congestive heart failure, hip fracture, and stroke), stratified by COVID status and payer type.
We found that COVID patients initially experienced substantially longer hospital stays (8.3 vs 4.6 days) and higher 30-day mortality (34% vs 5%) compared to patients without COVID. MA beneficiaries showed consistently higher home health utilization but similar mortality patterns to TM enrollees. By mid-2022, most outcome differences had converged between COVID and non-COVID patients, suggesting health system adaptation to the pandemic.
Our findings highlight how the pandemic was associated with shifts toward home-based post-acute care, emphasizing the need for policies supporting home-based care infrastructure and flexible care delivery models that could help health systems better adapt during future public health emergencies.
医疗保险受益人在突发公共卫生事件期间面临重大健康风险和医疗中断，但对于在整个新冠疫情期间医疗模式如何演变，或者传统医疗保险（TM）和医疗保险优势计划（MA）之间有何不同，我们知之甚少。
利用2018 - 2022年期间超过2000万例医院出院的医疗保险理赔数据，我们研究了患有5种主要合并症（痴呆症、糖尿病、充血性心力衰竭、髋部骨折和中风）的受益人的住院时长、出院处置和死亡率趋势，并按新冠感染状况和付款人类型进行分层。
我们发现，与未感染新冠的患者相比，感染新冠的患者最初住院时间显著更长（8.3天对4.6天），30天死亡率更高（34%对5%）。医疗保险优势计划受益人的家庭健康服务使用率一直较高，但死亡率模式与传统医疗保险参保人相似。到2022年年中，新冠患者和未感染新冠患者之间的大多数结果差异已经趋同，这表明卫生系统已适应疫情。
我们的研究结果凸显了疫情如何与向居家急性后护理的转变相关联，强调需要出台政策支持居家护理基础设施和灵活的护理提供模式，以帮助卫生系统在未来突发公共卫生事件期间更好地适应。
