Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings.
Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings.
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DOI：
10.1377/hlthaff.2012.1262
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发表时间：
2013-05
期刊：
影响因子：
--
通讯作者：
Holmes J
中科院分区：
文献类型：
--
作者：
Chandra A;Dalton MA;Holmes J
确定能够削减或限制美国医疗保健支出及支出增长的政策在改革工作中占主导地位，然而对于支出水平和支出增长的驱动因素是否相同却知之甚少。那些能一次性降低支出水平的政策，例如通过提高医院效率，可能对降低后续年度支出增长作用不大。为了确定导致医疗保健支出增长最快的因素，我们聚焦于医疗保险人群中的三种疾病：心脏病发作、充血性心力衰竭和髋部骨折。我们发现，急性病后护理（长期住院护理、康复护理和专业护理机构护理）方面的支出是增长最快的主要支出类别，并且在1994 - 2009年期间占支出增长的很大一部分。在此期间，髋部骨折患者的急性病后护理平均支出增加了一倍，充血性心力衰竭患者的支出增加了一倍多，心脏病发作患者的支出增加了两倍多。我们得出结论，如果旨在控制急性护理支出的政策（例如针对短期住院支出和医生服务的捆绑支付）能够涵盖急性病后护理，可能会更有效，就像目前在医疗保险的“改善护理捆绑支付倡议”下所测试的那样。
Identifying policies that will cut or constrain US health care spending and spending growth dominates reform efforts, yet little is known about whether the drivers of spending levels and of spending growth are the same. Policies that produce a one-time reduction in the level of spending, for example by making hospitals more efficient, may do little to reduce subsequent annual spending growth. To identify factors causing health care spending to grow the fastest, we focused on three conditions in the Medicare population: heart attacks, congestive heart failure, and hip fractures. We found that spending on postacute care—long-term hospital care, rehabilitation care, and skilled nursing facility care—was the fastest growing major spending category and accounted for a large portion of spending growth in 1994–2009. During that period average spending for postacute care doubled for patients with hip fractures, more than doubled for those with congestive heart failure, and more than tripled for those with heart attacks. We conclude that policies aimed at controlling acute care spending, such as bundled payments for short-term hospital spending and physician services, are likely to be more effective if they include postacute care, as is currently being tested under Medicare’s Bundled Payment for Care Improvement Initiative.
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影响因子：
8.4
作者：
Chandra, Amitabh;Jena, Anupam B.;Skinner, Jonathan S.
通讯作者：
Skinner, Jonathan S.
影响因子：
3.8
作者：
Finlayson, EVA;Birkmeyer, JD;Wennberg, DE
通讯作者：
Wennberg, DE
DOI：
10.1377/hlthaff.2010.0394
发表时间：
2011-09
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Sood N;Huckfeldt PJ;Escarce JJ;Grabowski DC;Newhouse JP
通讯作者：
Newhouse JP
DOI：
10.1377/hlthaff.2011.0783
发表时间：
2011-11
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Miller DC;Gust C;Dimick JB;Birkmeyer N;Skinner J;Birkmeyer JD
通讯作者：
Birkmeyer JD
影响因子：
120.7
作者：
UDVARHELYI, IS;GATSONIS, C;MCNEIL, BJ
通讯作者：
MCNEIL, BJ