Blustein J, Hanson K, Shea S
Wagner Graduate School, New York University, USA.
Health Aff (Millwood). 1998 Mar-Apr;17(2):177-89. doi: 10.1377/hlthaff.17.2.177.
"Preventable" hospitalizations have been proposed as indicators of poor health plan performance. In this study of elderly Medicare beneficiaries, however, we found that preventable hospitalizations are also more common among elders of lower socioeconomic status (SES). The relationship persisted even when an up-to-date severity-of-illness adjustment system was used. To the extent that indicators of health plan "performance" reflect enrollees' characteristics, plans will be rewarded for marketing their services to wealthier, healthier, and better-educated patients. Further work is needed to clarify issues of accountability for preventable hospitalizations and other putative indices of health plan performance.
“可避免的”住院治疗被提议作为衡量健康计划表现不佳的指标。然而，在这项针对老年医疗保险受益人的研究中，我们发现可避免的住院治疗在社会经济地位较低（SES）的老年人中也更为常见。即便使用了最新的疾病严重程度调整系统，这种关系依然存在。就健康计划“表现”指标反映参保者特征而言，计划会因向更富有、更健康且受教育程度更高的患者推销服务而得到奖励。需要进一步开展工作来厘清可避免住院治疗及其他假定的健康计划表现指标的问责问题。
