McCall N, Wai H S
Med Care. 1983 Jun;21(6):567-85. doi: 10.1097/00005650-198306000-00001.
This article discusses the utilization patterns of the Medicare aged who were continuously enrolled in the program for over a 4-year period. Data used for this study were compiled from a random sample of Medicare beneficiaries in Colorado who were continuously enrolled from October 1974 through December 1978. Five utilization variables: medical office visits, medical relative value units (RVUs), surgical RVUs, inpatient days, and covered dollars were examined in the article. Results from this study are consistent with previous longitudinal analyses. Consistent high users of services who consume substantial proportions of total expenditures and consistent nonusers having no or few services were found. During an average year of the 4-year period, it was observed that 18 per cent of the beneficiaries accounted for 88 per cent of the cost of services delivered. Because these high users tend to remain high users over time--more than one third of the high users in a given year continue to be high users during the following year--the findings here suggest that cost-containment strategies targeted to these high users may have a strong impact on overall Medicare program costs. Multivariate analysis is also conducted in this article so that the determinants of utilization patterns over time could be examined. Of particular interest is the finding that seasonal and trend variables play an important role in determining utilization over time.
本文讨论了连续参保医疗保险项目超过4年的老年参保者的使用模式。本研究使用的数据来自科罗拉多州医疗保险受益人的随机样本，这些受益人在1974年10月至1978年12月期间连续参保。文章考察了五个使用变量：门诊就诊次数、医疗相对价值单位（RVUs）、外科手术RVUs、住院天数和承保费用。本研究的结果与之前的纵向分析一致。研究发现了持续大量使用服务、占总支出很大比例的高使用人群，以及几乎不使用或很少使用服务的非使用人群。在这4年期间的平均一年中，观察到18%的受益人占所提供服务成本的88%。由于这些高使用人群往往长期保持高使用状态——某一年中超过三分之一的高使用人群在次年仍为高使用人群——此处的研究结果表明，针对这些高使用人群的成本控制策略可能会对医疗保险项目的总体成本产生重大影响。本文还进行了多变量分析，以便研究随时间变化的使用模式的决定因素。特别值得关注的是，季节性和趋势变量在决定随时间变化的使用情况方面发挥着重要作用。
