Chen Jie, Jang Seyeon
Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD.
Med Care. 2025 Jun 1;63(6):405-412. doi: 10.1097/MLR.0000000000002140. Epub 2025 Apr 24.
Little is known about the extent to which patient self-perception of care experience is associated with costs, especially for people with Alzheimer disease and related dementias (ADRD).
This study explores the relationship between self-reported quality measures and Medicare costs and examines whether the ease of obtaining prescribed medications is associated with reduced overall Medicare costs, focusing on Medicare beneficiaries with ADRD.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, Medicare Beneficiary Summary File data from 2018, 2019, and 2021 were linked to the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey using beneficiary IDs. The study sample included community-dwelling Medicare fee-for-service beneficiaries.
Five quality measures were used as key exposure variables: (1) beneficiary's rating on health care; (2) ease of getting care/tests/treatment through the health plan; (3) whether the doctor always explained, listened, respected; and spent enough time with the patient; (4) ease of obtaining prescribed medications; and (5) whether doctor always talked about all the prescription medicines the beneficiary was taking.
Annual total Medicare payments per person.
The study included 230,617 Medicare fee-for-service beneficiaries aged 65 and older, including 16,452 beneficiaries with ADRD. Among the total beneficiaries, 53% were females (vs. 56% of ADRD beneficiaries), with a mean (SD) age of 75.8 (SD 7.27) years [vs. 82.5 (SD 7.97) years for ADRD beneficiaries]. Fully adjusted analyses showed significant negative associations between quality measures and total per-capita payments, with more pronounced cost reductions among patients with ADRD. Specifically, patients with ADRD who reported it was always easy to get care had reductions of $1,922.0 (95% CI, -$3304.8 to -$539.2), while those who reported it was always easy to get prescribed medications had reductions of $2964.5 (95% CI, -$4518.8 to -$1410.1). In addition, beneficiaries who reported that doctors always discussed the medicines experienced cost reductions of $2299.7 (95% CI, -$3800.5 to -$799.0) in medicare costs.
Our findings suggest that high-quality care is not necessarily associated with high costs. Meanwhile, focusing on the ease of access to needed care, obtaining prescription drugs, and effective communication about medication is critical in improving care quality while reducing costs.
患者对护理体验的自我认知与成本之间的关联程度鲜为人知，尤其是对于患有阿尔茨海默病及相关痴呆症（ADRD）的人群。
本研究探讨自我报告的质量指标与医疗保险成本之间的关系，并研究获取处方药的便利性是否与降低医疗保险总成本相关，重点关注患有ADRD的医疗保险受益人。
设计、背景和参与者：在这项横断面研究中，利用受益人身份识别码将2018年、2019年和2021年的医疗保险受益人汇总文件数据与医疗保险医疗服务提供者和系统消费者评估（CAHPS）调查相链接。研究样本包括居住在社区的按服务收费的医疗保险受益人。
五项质量指标被用作关键暴露变量：（1）受益人对医疗保健的评分；（2）通过健康计划获得护理/检查/治疗的便利性；（3）医生是否总是进行解释、倾听、尊重患者并给予足够时间；（4）获取处方药的便利性；（5）医生是否总是谈论受益人正在服用的所有处方药。
每人每年的医疗保险总支付额。
该研究纳入了230,617名65岁及以上的按服务收费的医疗保险受益人，其中包括16,452名患有ADRD的受益人。在所有受益人中，53%为女性（ADRD受益人中这一比例为56%），平均（标准差）年龄为75.8（标准差7.27）岁[ADRD受益人平均年龄为82.5（标准差7.97）岁]。完全调整分析显示质量指标与人均总支付之间存在显著负相关，ADRD患者的成本降低更为明显。具体而言，报告总是容易获得护理的ADRD患者成本降低了1,922.0美元（95%置信区间，-3304.8美元至-539.2美元），而报告总是容易获得处方药的患者成本降低了2964.5美元（95%置信区间，-4518.8美元至-1410.1美元）。此外，报告医生总是讨论药物的受益人医疗保险成本降低了2299.7美元（95%置信区间，-3800.5美元至-799.0美元）。
我们的研究结果表明，高质量护理不一定与高成本相关。同时，关注获得所需护理、获取处方药的便利性以及关于药物的有效沟通对于提高护理质量同时降低成本至关重要。
