Physicians 'Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities
Physicians 'Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities
复制标题
DOI：
10.1377/hlthaff.2015.1635
复制
发表时间：
2016-08-01
期刊：
影响因子：
9.7
通讯作者：
Werner, Rachel M.
中科院分区：
文献类型：
--
作者：
Yasaitis, Laura C.;Pajerowski, William;Werner, Rachel M.
早期证据表明，问责医疗组织（ACOs）可以在控制成本的同时提高医疗质量，而且ACOs正在美国各地扩大。然而，如果弱势患者无法平等地获得参与ACOs的医生，这种扩大可能会加剧医疗保健差距。我们研究了医生在全国范围内参与医疗保险和商业ACOs与其可能患者群体的社会人口统计学特征之间的关系。医生参与ACOs的比例在医院转诊地区差异很大，从接近0%到85%以上。在我们调整了个体医生和执业特征后，我们发现，在邮政编码制表地区执业的医生，与其他地区相比，黑人、生活贫困、没有保险、残疾或高中教育程度以下的人口比例较高，他们的ACO参与率明显低于其他地区。我们的研究结果表明，弱势群体获得参加ACOs的医生的机会可能不如其他群体，这可能会加剧现有的医疗质量差距。
Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physicians' participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physicians' participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education-compared to other areas-had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations' access to physicians participating in ACOs may not be as great as access for other groups, which could exacerbate existing disparities in health care quality.