Impact of Health Insurance Patterns on Chronic Health Conditions Among Older Patients.
Impact of Health Insurance Patterns on Chronic Health Conditions Among Older Patients.
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DOI：
10.3122/jabfm.2023.230106r1
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发表时间：
2023-10-11
影响因子：
2.9
通讯作者：
Quinones, Ana R.
中科院分区：
文献类型：
--
作者：
Huguet, Nathalie;Hodes, Tahlia;Liu, Shuling;Marino, Miguel;Schmidt, Teresa D.;Voss, Robert W.;Peak, Katherine D.;Quinones, Ana R.
关键词：
患者有不同程度的慢性病和健康保险模式，因为他们成为医疗保险的年龄资格。了解这些动态将为政策和改革提供信息，指导初级保健诊所的能力和资源来照顾这些老年患者。这项研究1）确定了具有不同保险模式的患者在符合医疗保险年龄资格后慢性病发病率的变化，2）估计了在社区卫生中心接受护理的患者中，在符合医疗保险年龄资格后仍未获得充分保险的慢性病患者数量。我们使用了2014-2019年来自25个州990个社区卫生中心的45，527名62-68岁患者的回顾性电子健康记录数据。保险模式（连续投保，连续未投保，未投保/65岁后获得保险的不连续投保，65岁后失去保险，不连续投保）和慢性病的诊断在每次就诊前和后的医疗保险资格。差异中的差异泊松GEE模型估计的变化，慢性疾病率的保险集团前，后医疗保险的年龄资格。在符合医疗保险资格后，72%的患者连续投保，14%获得保险; 14%未投保或不连续投保。多发病（≥2种慢性疾病）的患病率为77%。与连续投保组相比，那些获得保险的人从医疗保险前到后记录的慢性疾病的比率显著增加（DID：1.06，95%CI：1.05-1.07）。医疗保险年龄合格后，很大一部分患者被诊断患有新的疾病，导致疾病负担沉重。四分之一的老年人在老年时仍然没有足够的医疗保险。
Patients have varying levels of chronic conditions and health insurance patterns as they become Medicare age-eligible. Understanding these dynamics will inform policies and reforms that direct capacity and resources for primary care clinics to care for these aging patients. This study 1) determined changes in chronic condition rates following Medicare age eligibility among patients with different insurance patterns and 2) estimated the number of chronically ill patients who remain inadequately insured post-Medicare eligibility among patients receiving care in community health centers. We used retrospective electronic health record data from 45,527 patients aged 62–68 from 990 community health centers in 25 states in 2014–2019. Insurance patterns (continuously insured, continuously uninsured, uninsured/discontinuously insured who gained insurance after age 65, lost insurance after age 65, discontinuously insured) and diagnosis of chronic conditions were defined at each visit pre- and post-Medicare eligibility. Difference-in-differences Poisson GEE models estimated changes of chronic condition rates by insurance groups pre- to post-Medicare age eligibility. Post-Medicare eligibility, 72% patients were continuously insured, 14% gained insurance; and 14% were uninsured or discontinuously insured. The prevalence of multimorbidity (≥2 chronic conditions) was 77%. Those who gained insurance had a significantly larger increase in the rate of documented chronic conditions from pre- to post-Medicare (DID: 1.06, 95%CI:1.05–1.07) compared with the continuously insured group. Post-Medicare age eligibility, a significant proportion of patients were diagnosed with new conditions leading to high burden of disease. One in 4 older adults continue to have inadequate health care coverage in their older age.
新的高血压和糖尿病诊断后，可负担得起的医疗补助法扩展。
影响因子：
6.1
作者：
Angier H;Huguet N;Ezekiel-Herrera D;Marino M;Schmidt T;Green BB;DeVoe JE
通讯作者：
DeVoe JE