Cost, utilization, and policy of provision of assistive technology devices to veterans poststroke by Medicare and VA.
Cost, utilization, and policy of provision of assistive technology devices to veterans poststroke by Medicare and VA.
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医疗保险和退伍军人管理局向中风后退伍军人提供辅助技术设备的成本、利用和政策。
DOI：
10.1097/mlr.0b013e3181bd4a11
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发表时间：
2010
期刊：
影响因子：
3
通讯作者：
Reker,DeanM
中科院分区：
文献类型：
--
作者：
Winkler,SandraLHubbard;Vogel,Bruce;Hoenig,Helen;Ripley,DianeCCowper;Wu,Samuel;Fitzgerald,ShirleyG;Mann,WilliamC;Reker,DeanM
背景：辅助技术设备（ATD）供应的增加引发了有关医疗保险政策的争议，该政策旨在减少迫使社会孤立和与立法冲突的成本政策，促进残疾人的参与。相比之下，退伍军人事务部 (VA) 的政策并不将 AT 的提供仅限于“家庭”使用，而是规定“所有登记的和一些未登记的退伍军人都有资格获得所有所需的假肢。”目标：通过比较 Medicare 和 VA 两个系统来检查 ATD 的提供政策。实证分析提供的 ATD 的差异、成本和重复提供。研究设计：对 VA 数据库（包括 VA Medicare 数据）进行回顾性研究。主题：一项针对 12, 0461 名中风后退伍军人的人口研究。措施：医疗保健通用程序代码提供 ATD 的频率、购买价格和上限租金支付。结果：在中风后退伍军人队列中，39% 的人没有接受 AT， 56% 的人仅从 VA 获得 AT，1% 的人仅从 Medicare 获得 AT，3% 的人同时从 VA 和 Medicare 获得 AT。大多数 ATD 用于日常生活活动，其次是助行器/手杖/拐杖。在特定的 ATD 比较中，VA 购买物品的成本大大低于 Medicare，并且略低于 Medicare 上限租金。结论：VA 以低于 Medicare 的成本提供更广泛的 ATD。对退伍军人管理局和医疗保险之间政策差异的分析表明，退伍军人管理局政策是由退伍军人需求驱动的，而医疗保险政策至少部分是通过控制因欺诈性索赔而飙升的成本来驱动的。
Background:The increase in provision of assistive technology devices (ATDs) has spurred controversy over Medicare policy aimed at reducing cost-policy that forces social isolation and conflicts with legislation, facilitating participation for individuals with disabilities. In contrast, Department of Veterans Affairs (VA) policy does not limit provision of AT to “in home” use only but rather, states “all enrolled and some non-enrolled veterans are eligible for all needed prosthetics.”Objectives:Examine ATD provision policy by comparing 2 systems, Medicare and VA. Empirically analyze differences in ATDs provided, cost, and duplication in provision.Research Design:Retrospective study of VA databases, including VA Medicare data.Subjects:A population based study of 12, 0461 veterans post-stroke.Measures:Frequency of provision of ATDs by Health Care Common Procedural Code, purchase price, and capped rental payments.Results:Of the poststroke veteran cohort, 39% received no AT, 56% received AT from the VA only, 1% received AT from Medicare only, and 3% received AT from both the VA and Medicare. Most ATDs were for activities of daily living, followed by walkers/canes/crutches. In specific ATD comparisons, VA costs were substantially lower than Medicare for purchased items and slightly lower than Medicare for capped rental payments.Conclusion:VA provides a broader variety of ATDs at a lesser cost than Medicare. Analyses of policy differences between VA and Medicare suggest VA policy is driven by veteran need whereas Medicare policy is driven at least in part, by containing costs that have skyrocketed as a result of fraudulent claims.