Grasso M E, Weller W E, Shaffer T J, Diette G B, Anderson G F
School of Medicine, Department of Health Policy and Management, and Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
Am J Respir Crit Care Med. 1998 Jul;158(1):133-8. doi: 10.1164/ajrccm.158.1.9710041.
Expenditure and utilization patterns of aged Medicare beneficiaries with chronic obstructive respiratory disease (COPD) (n = 42,472) were compared with all Medicare beneficiaries (n = 1,221,615) using a 5% nationally representative sample of aged Medicare beneficiaries participating in the fee-for-service program in 1992. Per capita expenditures for an aged Medicare beneficiary with COPD were 2.4 times the per capita expenditures for all Medicare beneficiaries. The most expensive 10% of Medicare beneficiaries with COPD accounted for nearly half of total expenditures for this population. Higher comorbidity, as measured by the Deyo-adapted Charlson index, was associated with higher expenditures. For Medicare Part B claims, internal medicine accounted for the largest portion of physician expenditures (14%). Per capita expenditures for pulmonologists were 7.5 times higher for beneficiaries with COPD compared with all Medicare beneficiaries. Results from this study suggest that there is a subgroup of individuals with COPD who are likely to be very expensive during the year. Additional analytic studies are needed to more specifically identify characteristics associated with these individuals. As more Medicare beneficiaries enroll in managed care and as physicians are increasingly being paid on a capitated basis this information will be useful to physicians as they monitor the care provided to patients and assess the financial risks they accept under capitation.
使用1992年参与按服务收费计划的5%具有全国代表性的老年医疗保险受益人的样本，将患有慢性阻塞性呼吸道疾病（COPD）的老年医疗保险受益人（n = 42,472）的支出和使用模式与所有医疗保险受益人（n = 1,221,615）进行比较。患有COPD的老年医疗保险受益人的人均支出是所有医疗保险受益人平均支出的2.4倍。患有COPD的医疗保险受益人中花费最高的10%占该人群总支出的近一半。通过Deyo调整后的Charlson指数衡量，较高的合并症与较高的支出相关。对于医疗保险B部分索赔，内科医生支出占医生支出的最大部分（14%）。患有COPD的受益人的肺科医生人均支出比所有医疗保险受益人高出7.5倍。这项研究的结果表明，有一部分COPD患者在这一年中可能花费非常高。需要进行更多的分析研究，以更具体地确定与这些患者相关的特征。随着越来越多的医疗保险受益人加入管理式医疗，以及医生越来越多地按人头付费，这些信息对于医生监测为患者提供的护理以及评估他们在按人头付费情况下所承担的财务风险将是有用的。
