Lave J R, Ives D G, Traven N D, Kuller L H
Department of Health Services Administration, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
Health Serv Res. 1996 Aug;31(3):261-81.
This article evaluates a demonstration program that extended coverage for disease prevention/health promotion services to Medicare beneficiaries.
STUDY SETTING/DATA SOURCES: Community-dwelling Medicare beneficiaries who lived in five rural counties in northwest Pennsylvania were recruited between May and December 1989. The demonstration lasted 18 months and beneficiaries were followed for an additional 18 months. Data for the evaluation came from an initial health risk assessment, Medicare administrative records, follow-up surveys, and redeemed vouchers for the waivered services. The waivered services included health screenings, influenza immunization, nutritional counseling, smoking and alcohol cessation, and depression/dementia evaluations.
Medicare beneficiaries were randomized to one of two experimental groups and a control group. One experimental group received the newly waived services from hospitals that received a capitated fee; the other received services from providers who were paid fee-for-service. Eligibility for most waivered services was based on risk. Chi-square tests of association were used to determine if use of health promotion services and use of medical care services varied across groups. Logistic regressions were used to assess the factors associated with participation. Product-limit survival analysis was used to assess whether mortality rates varied across groups.
Participation rates in the new programs varied by program and by experimental group, and ranged from 16.8 percent for smoking cessation programs to 58 percent for influenza immunization. The demonstration led to an increase in influenza immunization rates relative to the control group. There were no differences in the use of medical care services or health outcomes between the experimental and control groups.
Older rural Americans will modestly increase their use of disease prevention/ health promotion services if they are covered by Medicare. Use will be higher among those with more education. Further research is needed to assess long-term benefits of such programs.
本文评估了一项示范项目，该项目将疾病预防/健康促进服务的覆盖范围扩大到了医疗保险受益人。
研究背景/数据来源：1989年5月至12月期间，招募了居住在宾夕法尼亚州西北部五个农村县的社区居家医疗保险受益人。示范项目持续了18个月，并对受益人进行了额外18个月的跟踪。评估数据来自初始健康风险评估、医疗保险行政记录、随访调查以及减免服务的兑换凭证。减免服务包括健康筛查、流感疫苗接种、营养咨询、戒烟和戒酒以及抑郁症/痴呆症评估。
医疗保险受益人被随机分配到两个实验组之一和一个对照组。一个实验组从获得按人头付费的医院接受新的减免服务；另一个实验组从按服务收费的提供者那里接受服务。大多数减免服务的资格基于风险。使用卡方关联检验来确定健康促进服务的使用和医疗服务的使用在不同组之间是否存在差异。使用逻辑回归来评估与参与相关的因素。使用乘积限生存分析来评估死亡率在不同组之间是否存在差异。
新项目的参与率因项目和实验组而异，范围从戒烟项目的16.8%到流感疫苗接种的58%。与对照组相比，该示范项目导致流感疫苗接种率上升。实验组和对照组在医疗服务使用或健康结果方面没有差异。
如果医疗保险覆盖，美国农村老年人将适度增加对疾病预防/健康促进服务的使用。受教育程度较高的人使用量会更高。需要进一步研究来评估此类项目的长期效益。
