Lapses in Medicaid Coverage Impact on Cost and Utilization Among Individuals With Diabetes Enrolled in Medicaid
Lapses in Medicaid Coverage Impact on Cost and Utilization Among Individuals With Diabetes Enrolled in Medicaid
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DOI：
10.1097/mlr.0b013e31817d695c
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发表时间：
2008-12-01
期刊：
影响因子：
3
通讯作者：
Zhang, Jianyi
中科院分区：
文献类型：
--
作者：
Hall, Allyson G.;Harman, Jeffrey S.;Zhang, Jianyi
背景：医疗补助覆盖范围的差距可能导致获得护理的机会不足。这可能是特别有害的那些与慢性疾病，如diabetes.Objective：为了评估是否失效的医疗补助覆盖范围是与增加支出，和急性护理利用后，再登记受益人与糖尿病。研究设计：使用多元回归分析，我们比较了2102名糖尿病患者的医疗补助覆盖范围至少有一个月失效的前后支出和利用情况。因变量为住院次数、住院总时间、急诊总次数、总支出和药物支出。这些数据是在覆盖率下降之前或之后的3个月内汇总的。关键的预测变量包括一个变量，确定的跨度发生前失效或失效后的覆盖范围，和一个连续的变量，确定失效的长度。预测支出和利用率calculated.Results：总体总计划支出较高的失效后期间相比，失效前期间。估计在3个月期间，每个成员每月的总支出将增加239美元。在失效后的一段时间内，发生任何支出的可能性实际上较低。然而，住院和急诊室的使用率较高。结论：从这项研究的结果表明，医疗补助覆盖范围的中断与整体更大的计划支出在失效后的时期。然而，支出的增加似乎是由一部分人推动的，他们更多地使用住院和急诊室服务增加了总体项目成本。
Background: Gaps in Medicaid coverage can result in inadequate access to care. This can be particularly detrimental to those with a chronic disease such as diabetes.Objective: To assess whether a lapse in Medicaid coverage is associated with an increase in expenditures, and acute care utilization upon reenrollment among beneficiaries with diabetes.Research Design: Using multivariate regression analyses, we compared pre- versus post-expenditures and utilization among 2102 individuals with diabetes who had experienced at least one 1-month lapse in their Medicaid coverage.Measures: Dependent variables were the number of inpatient episodes, total length of stay, total number of emergency room visits, total expenditure, and pharmaceutical expenditures. These were aggregated over 3-month spans that either immediately preceded or immediately followed a lapse in coverage. Key predictor variables included a variable that identified the span as occurring pre-lapse or post-lapse in coverage, and a continuous variable identifying the length of the lapse. Predicted expenditure and utilization were calculated.Results: Overall total program expenditures were higher for post-lapse periods compared with pre-lapse periods. Total expenditures were estimated to increase by $239 per member per month for the 3-month period. The likelihood of having any expenditure was actually lower in the post-lapse period. However inpatient and emergency room use was higher.Conclusions: The results from this study Suggest that interruptions in Medicaid coverage are associated with overall greater program expenditures in the post-lapse periods. However, this increase in expenditures seems to be driven by a subset of individuals whose greater use of inpatient and emergency room services increased overall program costs.