Disability and health care costs in the medicare population
Disability and health care costs in the medicare population
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DOI：
10.1053/apmr.2002.34811
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发表时间：
2002-09-01
影响因子：
4.3
通讯作者：
Doctor, JN
中科院分区：
文献类型：
--
作者：
Chan, L;Beaver, S;Doctor, JN
目标：确定活动限制对医疗保健支出的影响。设计：横断面。设置：全国调查。参与者：数据来自1997年医疗保险当前受益人调查（n=9298），一个年龄超过64岁的社区居住医疗保险受益人的全国代表性样本。干预措施：不适用。主要结果测量：患者残疾对医疗保健成本的影响（住院、门诊、专业护理设施、家庭健康、药物）。活动限制由患者评估的限制，在日常生活活动（ADLs）。结果：超过20%（n= 6，500，000）的整个医疗保险人口至少有1个健康相关的活动限制。随着这些限制数量的增加，每年的总中位医疗保健费用（四分位距[IQR]）也增加（0例ADL：1934美元[IQR，801 - 4761美元]; 1-2例ADL：4540美元[IQR，1744 - 12,937美元]; 3-4例ADL：7589美元）。[IQR，$2580-$23，149]; 5-6 ADL：$14，399 [IQR，$5425-$33，014]）。在调整了混杂特征（包括合并症的影响）后，随着活动限制数量的增加，Medicare登记者的医疗保健费用也会增加（0例ADL：成本比=1.0; 1-2例ADL：成本比=1.4 [95%置信区间（CI），1.2-1.6]; 3-4例ADL：成本比=1.6 [95% CI，1.3-2.0]; 5-6例ADL：成本比=2.3 [95% CI，1.7-3.2]）。成本增加是因为所有事件（例如，住院、门诊访视）的频率增加，而不是这些事件的强度或成本增加。此外，随着活动限制的增加，有一个显着增加的家庭医疗费用的比例影响，这样，对于那些有5或6个限制，家庭医疗费用超过了门诊visits.Conclusions的成本：活动限制是一个独立的风险因素，增加医疗费用，似乎不仅仅是一个代理慢性疾病。
Objective: To determine the effect of activity limitations on health care expenditures.Design: Cross-sectional.Setting: National survey.Participants: Data from the 1997 Medicare Current Beneficiary Survey (n=9298), a nationally representative sample of community-dwelling Medicare beneficiaries who were older than 64 years of age.Interventions: Not applicable.Main Outcome Measures: The impact of patient disability on health care costs (inpatient, outpatient, skilled nursing facility, home health, medications). Activity limitations were determined by patient assessment of restrictions in activities of daily living (ADLs).Results: Over 20% (n=6,500,000) of the entire Medicare population had at least 1 health-related activity limitation. Total median health care costs per year (interquartile range [IQR]) increased as the number of these limitation increased (0 ADLs: $1934 [IQR, $801-$4761]; 1-2 ADLs: $4540 [IQR, $1744-$12,937]; 3-4 ADLs: $7589.[IQR, $2580-$23,149]; 5-6 ADLs: $14,399 [IQR, $5425-$33,014]). After adjusting for confounding characteristics including the impact of comor-bid illnesses, Medicare enrollees incurred higher health care costs as their number of activity limitations increased (0 ADLs: cost ratio=1.0; 1-2 ADLs: cost ratio=1.4 [95% confidence interval (CI), 1.2-1.6]; 3-4 ADLs: cost ratio=1.6 [95% CI, 1.3-2.0]; 5-6 ADLs: cost ratio=2.3 [95% CI, 1.7-3.2]). The cost increases were because of an increase in the frequency of all events (eg, hospital admissions, outpatient visits) rather than an increase in the intensity or cost of those events. In addition, with increasing activity limitations, there was a significant increase in the proportional impact of home health costs such that, for those with 5 or 6 limitations, home health costs exceeded the cost of outpatient visits.Conclusions: Activity limitation is an independent risk factor for increased health care costs and appears to be more than just a proxy for chronic illness.