Among Dual Eligibles, Identifying The Highest-Cost Individuals Could Help In Crafting More Targeted And Effective Responses
Among Dual Eligibles, Identifying The Highest-Cost Individuals Could Help In Crafting More Targeted And Effective Responses
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DOI：
10.1377/hlthaff.2011.0729
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发表时间：
2012-05-01
期刊：
影响因子：
9.7
通讯作者：
Phadera, Lokendra
中科院分区：
文献类型：
--
作者：
Coughlin, Teresa A.;Waidmann, Timothy A.;Phadera, Lokendra
享受医疗保险和医疗补助福利（称为双重资格）的近 900 万人构成了美国最脆弱和最昂贵的人群之一。 《平价医疗法案》授权的几项举措旨在改善向双重资格者提供的医疗保健，同时更好地控制这两个政府计划的支出增长。我们检查了 2007 年与双重资格相关的成本和服务使用情况。尽管人口成本确实很高，但我们发现近 40% 的双重资格受益人的人均支出低于非双重资格的 Medicare 受益人。此外，我们发现大约 20% 的双重资格人群占双重资格人群医疗补助和医疗保险总支出的 60% 以上。但即使在这些高成本的双重合格者中，我们也发现了亚组。例如，只有不到 1% 的双重资格者同时属于 Medicare 和 Medicaid 的高费用类别。这些发现表明，决策者应制定改革举措，以考虑双重资格的子群体、他们的成本和服务的使用。
The nearly nine million people who receive Medicare and Medicaid benefits, known as dual eligibles, constitute one of the nation's most vulnerable and costly populations. Several initiatives authorized by the Affordable Care Act are intended to improve the health care delivered to dual eligibles and, at the same time, to achieve greater control of spending growth for the two government programs. We examined the 2007 costs and service use associated with dual eligibles. Although the population is indeed costly, we found nearly 40 percent of dual eligibles had lower average per capita spending than non-dual-eligible Medicare beneficiaries. In addition, we found that about 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending on the dual-eligible population. But even among these high-cost dual eligibles, we found subgroups. For example, fewer than 1 percent of dual eligibles were in high-cost categories for both Medicare and Medicaid. These findings suggest that decision makers should tailor reform initiatives to account for subpopulations of dual eligibles, their costs, and their service use.