Trends in Health Care Expenditures, Utilization, and Health Status Among US Adults With Spine Problems, 1997-2006
Trends in Health Care Expenditures, Utilization, and Health Status Among US Adults With Spine Problems, 1997-2006
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DOI：
10.1097/brs.0b013e3181b1fad1
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发表时间：
2009-09-01
期刊：
影响因子：
3
通讯作者：
Deyo, Richard A.
中科院分区：
文献类型：
--
作者：
Martin, Brook I.;Turner, Judith A.;Deyo, Richard A.
研究设计。对全国具有代表性的脊柱相关医疗费用、利用和自报健康状况的调查数据进行分析。研究1997-2006年脊柱相关住院、门诊、药房和急救服务的人均支出趋势，并将这些趋势与健康状况的变化进行比较。尽管先前的工作显示，2005年与脊柱相关的总支出为860亿美元，自1997年以来增长了65%，但该研究没有报告每个用户的支出。了解与健康状况变化相关的特定服务的人口水平人均支出可能有助于评估这些服务的价值。我们分析了来自医疗支出小组调查的数据，这是一个多阶段调查样本，旨在产生对医疗保健利用和支出的无偏见的国家估计。使用ICD-9-CM诊断代码识别与脊柱相关的住院、门诊就诊、处方药和急诊科就诊。控制年龄、性别、共病和时间(年)的回归分析被用来检查1997-2006年间经通货膨胀调整的人均支出、使用率和自我报告的健康状况的趋势。平均每年有1,774名有脊柱问题的受访者接受调查；这一比例表明，美国因脊柱问题寻求治疗的人数从1997年的1,480万人增加到2006年的2,190万人。从1997年到2006年，每位用户的平均调整支出是住院、处方药和急诊科就诊总成本增加的最大组成部分，分别增长了37%(从1997年的13,040美元增加到2006年的17,909美元)、139%(从166美元增加到397美元)和84%(从81美元增加到149美元)。寻求脊柱相关护理的患者数量增加了49%(从1997年的1220万人增加到2006年的1820万人)，这是导致门诊支出增加的最大因素。脊柱问题患者的心理健康以及工作、社交和身体限制的人口测量随着时间的推移而恶化。与脊柱相关的住院、处方和急救服务的支出增加主要是由于每个用户的支出增加，而与门诊服务相关的支出增加主要是由于使用门诊服务的人数增加。
Study Design. Analysis of nationally representative survey data for spine-related health care expenditures, utilization and self-reported health status.Objective. To study trends from 1997 to 2006 in per-user expenditures for spine-related inpatient, outpatient, pharmacy, and emergency services; and to compare these trends to changes in health status.Summary of Background Data. Although prior work has shown overall spine-related expenditures accounted for $86 billion in 2005, increasing 65% since 1997, the study did not report per-user expenditures. Understanding population-level per-user expenditure for specific services relative to changes in the health status may help assess the value of these services.Methods. We analyzed data from the Medical Expenditure Panel Survey, a multistage survey sample designed to produce unbiased national estimates of health care utilization and expenditure. Spine-related hospitalizations, outpatient visits, prescription medications and emergency department visits were identified using ICD-9-CM diagnosis codes. Regression analyses controlling for age, sex, comorbidity, and time (years) were used to examine trends from 1997 to 2006 in inflation-adjusted per-user expenditures, and utilization, and self-reported health status.Results. An average of 1774 respondents with spine problems was surveyed per year; the proportion suggested an increase in the number of people who sought treatment for spine problems in the United States from 14.8 million in 1997 to 21.9 million in 2006. From 1997 to 2006, the mean adjusted per-user expenditures were the largest component of increasing total costs for inpatient hospitalizations, prescription medications, and emergency department visits, increasing 37% (from $13,040 in 1997 to $17,909 in 2006), 139% (from $166 to $397), and 84% (from $81 to $149), respectively. A 49% increase in the number of patients seeking spine-related care (from 12.2 million in 1997 to 18.2 million in 2006) was the largest contributing factor to increased outpatient expenditures. Population measures of mental health and work, social, and physical limitations worsened over time among people with spine problems.Conclusion. Expenditure increases for spine-related inpatient, prescription, and emergency services were primarily the result of increasing per-user expenditures, while those related to outpatient visits were primarily due to an increase in the number of users of ambulatory services.