Medicaid Pay for Performance Programs and Childhood Immunization Status.
Medicaid Pay for Performance Programs and Childhood Immunization Status.
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DOI：
10.1016/j.amepre.2016.01.012
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发表时间：
2016-05
影响因子：
5.5
通讯作者：
Chou SY
中科院分区：
文献类型：
--
作者：
Hu T;Decker SL;Chou SY
尽管各州医疗补助计划越来越多地使用绩效付费（P4P）计划来激励管理式医疗计划，以提供高质量的医疗服务，但没有全国性的研究调查这些计划对通常目标结果的影响，如使用特定的预防性医疗服务。我们使用来自医疗保险和医疗补助服务中心的州医疗补助P4P计划的信息，结合1999-2011年全国免疫调查的信息，研究医疗补助P4P计划对儿童免疫状况的影响。我们使用异中异模型来比较P4P计划对儿童免疫状况的影响，这些儿童在引入P4P计划之前和之后估计符合医疗补助资格，相对于同一组州的其他儿童的“前后”变化。我们还估计了将这些变化与未实施P4P的州的儿童的变化进行比较的差异中差异模型。我们发现，医疗补助P4P增加了西班牙裔或非西班牙裔白人儿童最新接种几种疫苗的可能性。例如，我们发现这些儿童获得最新的腮腺炎和风疹系列措施的机会增加了约2.7-2.9个百分点。然而，我们没有发现对所有疫苗都有统计学意义上的显著影响，对非西班牙裔黑人儿童也没有统计学意义上的显著影响。这项研究提供了一些证据，证明医疗补助P4P计划可能有助于提高儿童疫苗接种率。进一步研究对其他目标结果的影响，以及不同P4P方案设计的影响，可能会进一步增加我们对这些方案潜在作用的理解。
Although Pay-for-Performance (P4P) programs are being increasingly used by state Medicaid programs to provide incentives for managed care plans to provide high quality care, no national study has examined the effects of these plans on commonly targeted outcomes such as the use of particular preventive care services. We use information on state Medicaid P4P programs from the Centers for Medicare and Medicaid Services combined with information from the National Immunization Survey 1999–2011 to study the effect of Medicaid P4P programs on children’s immunization status. We use difference-in-difference models that compare the effect of P4P programs on children’s immunization status for children estimated to be Medicaid-eligible before and after introduction of a P4P program relative to the “pre-post” change for other children in the same group of states. We also estimate difference-in-difference-in-difference models that compare these changes to those for children in states that do not implement P4P. We find that Medicaid P4P increases the probability that a Hispanic or non-Hispanic white child is up-to-date on several vaccinations. For example, we find that the chance that these children are up-to-date on the measures, mumps, and rubella series increased by about 2.7–2.9 percentage points. However, we do not find statistically significant effects on all vaccines, and no statistically significant effects for non-Hispanic black children. This study provides some evidence that Medicaid P4P programs may be helpful in improving childhood vaccination rates. Further study of the effects on other targeted outcomes as well as the effects of different P4P program designs may further increase our understanding of the potential role of these programs.
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影响因子：
--
作者：
Gupta SK
通讯作者：
Gupta SK
影响因子：
9.7
作者：
Lipton, Brandy J.;Decker, Sandra L.
通讯作者：
Decker, Sandra L.
影响因子：
5.4
作者：
Lipton, Brandy J.;Decker, Sandra L.
通讯作者：
Decker, Sandra L.
影响因子：
5.2
作者：
Maral, I;Baykan, Z;Bumin, MA
通讯作者：
Bumin, MA
影响因子：
2.1
作者：
De La Mata, Dolores
通讯作者：
De La Mata, Dolores