Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia.
Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia.
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病程中的种族和民族差异 痴呆症受益人的医疗保险支出。
DOI：
10.1111/jgs.18822
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发表时间：
2024
影响因子：
6.3
通讯作者：
Lin,Pei-Jung
中科院分区：
文献类型：
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作者：
Olchanski,Natalia;Zhu,Yingying;Liang,Lichen;Cohen,JoshuaT;Faul,JessicaD;Fillit,HowardM;Freund,KarenM;Lin,Pei-Jung
背景：关于痴呆症治疗费用的种族和民族差异的研究很少。我们分析了痴呆症受益人的医疗保险支出，以确定在护理过程中何时费用最高，以及它们是否因种族和民族而异。我们分析了2000-2016年健康与退休研究（HRS）的数据，并与相应的医疗保险索赔相关联，以估计四个阶段的医疗保险总支出：（1）痴呆症诊断前一年，（2）痴呆症诊断后的第一年，（3）第一年后持续护理痴呆症，（4）生命的最后一年。我们通过使用种族特异性生存模型和根据患者特征调整的每月支出来估计每个患者的阶段特异性和疾病过程医疗保险支出。我们调查了不同种族/民族和护理阶段的服务类型的医疗保健利用率。结果：非西班牙裔（NH）黑人（165，730）和西班牙裔痴呆症患者的调整后平均医疗保险总支出（160，442）超过了NH白人（136，326）的相应支出。在最初痴呆症诊断之前和之后的一年中，NH黑人的平均医疗保险支出（26，337和20，429）超过西班牙裔和新罕布什尔州白人（21，399 - 23，176和17，182 - 18，244）的支出。生命的最后一年是最大的成本贡献：51,294（NHBlacks），47，469（西班牙裔）和39，499（新罕布什尔州白人）。这些差异是由高成本服务的过度使用造成的结论NHBlack和Hispanic痴呆患者的病程医疗费用高于NHWhite，NHBlack痴呆患者在各个治疗阶段的医疗费用最高，进一步的研究应关注这些疾病的机制，并确定改善痴呆的方法，共享决策权，并为所有人群提供适当的服务。
Background Research on racial and ethnic disparities in costs of care during the course of dementia is sparse. We analyzed Medicare expenditures for beneficiaries with dementia to identify when during the course of care costs are the highest and whether they differ by race and ethnicity. Methods We analyzed data from the 2000–2016 Health and Retirement Study (HRS) linked with corresponding Medicare claims to estimate total Medicare expenditures for four phases:(1) the year before a dementia diagnosis,(2) the first year following a dementia diagnosis,(3) ongoing care for dementia after the first year, and (4) the last year of life. We estimated each patient's phase‐specific and disease course Medicare expenditures by using a race‐specific survival model and monthly expenditures adjusted for patient characteristics. We investigated healthcare utilization by service type across races/ethnicities and phases of care. Results Adjusted mean total Medicare expenditures for non‐Hispanic (NH) Black (165,730)andHispanicbeneficiarieswithdementia( 160,442) exceeded corresponding expenditures for NH Whites (136,326).Intheyearprecedingandimmediatelyfollowinginitialdementiadiagnosis,meanMedicareexpendituresforNHBlacks( 26,337 and 20,429)exceededexpendituresforHispanicsandNHWhites( 21,399–23,176 and 17,182–18,244). The last year of life was responsible for the greatest cost contribution: 51,294(NHBlacks), 47,469 (Hispanics), and 39,499(NHWhites).Thesedifferencesweredrivenbygreateruseofhigh‐costservices(eg,emergencydepartment,inpatientandintensivecare),especiallyduringthelastyearoflife.ConclusionsNHBlackandHispanicbeneficiarieswithdementiahadhigherdiseasecourseMedicareexpendituresthanNHWhites.ExpenditureswerehighestforNHBlackbeneficiariesineveryphaseofcare.Furtherresearchshouldaddressmechanismsofsuchdisparitiesandidentifymethodstoimprovecommunication,shareddecision‐making,andaccesstoappropriateservicesforallpopulations.