Switching Between Medicare Advantage And Traditional Medicare Before And After The Onset Of Functional Disability.
Switching Between Medicare Advantage And Traditional Medicare Before And After The Onset Of Functional Disability.
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DOI：
10.1377/hlthaff.2019.01070
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发表时间：
2020-05
期刊：
影响因子：
--
通讯作者：
Kelley AS
中科院分区：
文献类型：
--
作者：
Ankuda CK;Ornstein KA;Covinsky KE;Bollens-Lund E;Meier DE;Kelley AS
联邦医疗保险优势(MA)计划具有越来越大的灵活性，可以提供非医疗服务，以支持社区中的老年人。然而，先前的研究表明，有功能残疾(以下简称“残疾”)的参保人比非残疾人士更有可能离开MA计划。这表明，MA计划可能无法满足残疾老年人的需求。我们使用了2011-16年度与Medicare声称相关的National Health and Aging Trends Study中的数据，来衡量和描述在残疾发生前后的12个月中，Medicare Advantage和传统Medicare之间的双向切换。虽然在残疾发作后，从Medicare Advantage切换到传统Medicare的比率略有增加，但与残疾程度较低的人相比，残疾程度较高的人更有可能转向传统Medicare：从Medicare Advantage切换到传统Medicare的人中，36%的人在两项或两项以上的日常生活活动方面需要帮助，而从传统Medicare切换到Medicare Advantage的人中，这一比例为14.3%。这表明了将功能措施纳入管理计划、风险调整和质量措施的潜在好处。此外，最有需要的残疾老年人可能会在Medicare Advantage中享受较低质量的护理，因此在享受该计划扩大的福利之前离开。
Medicare Advantage (MA) plans have increasing flexibility to provide nonmedical services to support older adults aging in place in the community. However, prior research has suggested that enrollees with functional disability (hereafter, “disability”) were more likely than those without disability to leave MA plans. This indicates that MA plans might not meet the needs of older adults with disability. We used data for 2011–16 from the National Health and Aging Trends Study linked to Medicare claims to measure and characterize switches in either direction between Medicare Advantage and traditional Medicare in the twelve months before and after onset of disability. While the rate of switches from Medicare Advantage to traditional Medicare increased slightly after disability onset, people with greater levels of disability were more likely to switch to traditional Medicare, compared to those with lower levels: 36 percent of those who switched from Medicare Advantage to traditional Medicare needed help with two or more activities of daily living, compared to 14.3 percent of those who switched from traditional Medicare to Medicare Advantage. This indicates the potential benefit of including functional measures in MA plan risk adjustment and quality measures. Furthermore, the highest-need older adults with disability may experience lower-quality care in Medicare Advantage and thus leave before accessing the program’s expanded benefits.
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DOI：
10.1093/geronb/gbu124
发表时间：
2014-11-01
影响因子：
6.2
作者：
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影响因子：
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