State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment
复制标题
DOI：
10.1111/1475-6773.13205
复制
发表时间：
2019-10-01
影响因子：
3.4
通讯作者：
Sabik, Lindsay M.
中科院分区：
文献类型：
--
作者：
Roberts, Eric T.;Mellor, Jennifer M.;Sabik, Lindsay M.
目的探讨双重参加医疗补助的医疗保险受益人在社会经济和健康特征方面的州间差异，重点关注政策制定者在风险调整中无法观察到或使用的特征。数据来源2010-2013年医疗保险现行受益人调查。研究设计对低收入医疗保险受益人和低收入双重参保者的调查报告健康和社会经济地位（SES）措施进行回顾性分析。我们使用具有州随机效应的层次线性回归模型来估计受访者特征在州间的变化，并使用线性模型来比较各州医疗补助政策下双重参保者的特征。主要发现：在低收入医疗保险受益人中，健康和社会经济风险在各州之间的差异，通过变异系数来衡量，从社会经济风险指数的17.5%到健康风险指数的20.3%不等。在同时参加医疗保险和医疗补助的低收入受益人中，州与州之间的差异具有可比性。在向收入相对较高的个人提供医疗补助的州，收入低于联邦贫困线的双重参保人健康状况更好，社会经济地位也更高。在有医疗需求项目的州，双职工的平均收入更高。双重参保者的特征在各州之间存在很大差异，这反映了各州低收入医疗保险人群和医疗补助政策的差异。采用双入组的风险调整方法来代替健康状况不佳和社会经济地位低的人应该考虑到这种州一级的异质性。
Objective To examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. Data Source 2010-2013 Medicare Current Beneficiary Survey. Study Design Retrospective analyses of survey-reported health and socioeconomic status (SES) measures among low-income Medicare beneficiaries and low-income dual enrollees. We used hierarchical linear regression models with state random effects to estimate the between-state variation in respondent characteristics and linear models to compare the characteristics of dual enrollees by state Medicaid policies. Principal Findings Between-state differences in health and socioeconomic risk among low-income Medicare beneficiaries, as measured by the coefficient of variation, ranged from 17.5 percent for an index of socioeconomic risk to 20.3 percent for an index of health risk. Between-state differences were comparable among the subset of low-income beneficiaries dually enrolled in Medicare and Medicaid. Dual enrollees with incomes below the Federal Poverty Level were in better health and had higher SES in states that offered Medicaid to individuals with relatively higher incomes. Duals' average incomes were higher in states with Medically Needy programs. Conclusions Characteristics of dual enrollees differ substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies. Risk-adjustment methods using dual enrollment to proxy for poor health and low SES should account for this state-level heterogeneity.