Does Vertical Integration Improve Access to Surgical Care for Medicaid Beneficiaries?
Does Vertical Integration Improve Access to Surgical Care for Medicaid Beneficiaries?
复制标题
垂直整合是否可以改善医疗补助受益人获得手术护理的机会？
DOI：
10.1016/j.jamcollsurg.2019.09.016
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发表时间：
2020-01
影响因子：
5.2
通讯作者：
Nikpay, Sayeh S.
中科院分区：
文献类型：
--
作者：
Haddad, Diane N.;Resnick, Matthew J.;Nikpay, Sayeh S.
垂直整合在美国外科专业中越来越普遍;然而，垂直整合对低收入人群获得护理的影响仍然知之甚少。我们探讨了与纵向整合相关的外科实践的特点，以及整合对医疗补助人群手术通道的影响。通过对美国办公室医生实践的调查，我们研究了2007年至2017年15个外科亚专业的特征，包括提供者性别和专业，实践支付者组合，手术量和县社会经济地位。使用多变量逻辑回归和时间序列分析，我们评估了与垂直整合相关的实践和提供者特征-我们的主要结果-和实践医疗补助接受率-我们的次要结果。我们的分析包括84，795个独特的手术实践（303，903个实践年）。10年期间的垂直整合率为18.0%，72.1%的手术实践从未整合。整合的做法比没有整合的做法更容易接受医疗补助患者（81.0%对60.8%，p < 0.001）。接受医疗补助增加了垂直整合的可能性，相对于没有的做法（比值比[OR] 4.20，95% CI 3.93至4.49）。整合的实践更有可能在未来接受医疗补助（OR 2.61，95% CI 2.40至2.83），即使在调整了以前的医疗补助接受和医院和时间固定的影响。在市场特征的驱动下，照顾保险不足的外科手术更有可能加入更大的医疗保健系统。纵向一体化与未来医疗补助接受率的增加有关，允许弱势，低收入患者获得更多的手术护理。纵向一体化使低收入受益者获得更多手术机会的潜在好处必须与价格上涨的可能性相平衡。
Vertical integration is increasingly common among surgical specialties in the US; however, the effect of vertical integration on access to care for low-income populations remains poorly understood. We explored the characteristics of surgical practices associated with vertical integration and the effect of integration on surgical access for Medicaid populations. Using a survey of US office-based physician practices, we examined characteristics of 15 surgical subspecialties from 2007 to 2017, including provider sex and specialty, practice payer mix, surgical volume, and county socioeconomic status. Using multivariable logistic regression and time-series analysis, we evaluated practice and provider characteristics associated with vertical integration—our primary outcome—and practice Medicaid acceptance rates—our secondary outcome. Our analysis included 84,795 unique surgical practices (303,903 practice-years). The rate of vertical integration during the 10-year period was 18.0%, with 72.1% of surgical practices never integrating. Practices that integrated were more likely to accept Medicaid patients than practices that did not (81.0% vs 60.8%, p < 0.001). Accepting Medicaid increased the likelihood of vertical integration relative to practices that did not (odds ratio [OR] 4.20, 95% CI 3.93 to 4.49). Practices that integrated were more likely to accept Medicaid in the future (OR 2.61, 95% CI 2.40 to 2.83), even after adjusting for previous Medicaid acceptance and hospital and time fixed effects. Surgical practices caring for the underinsured are more likely to join larger health care systems, driven by market characteristics. Vertical integration is associated with future increased rates of Medicaid acceptance among practices, allowing for increased access to surgical care for vulnerable, low-income patients. The potential benefit of increased surgical access for low-income beneficiaries from vertical integration must be balanced with the potential for increased prices.
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影响因子：
39
作者：
Neprash, Hannah T.;Chernew, Michael E.;McWilliams, J. Michael
通讯作者：
McWilliams, J. Michael
影响因子：
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作者：
Charles, Anthony G.;Ortiz-Pujols, Shiara;Sheldon, George F.
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3
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9.7
作者：
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通讯作者：
Penson, David
影响因子：
3.4
作者：
Richards, Michael R.;Smith, Catherine T.;Resnick, Matthew J.
通讯作者：
Resnick, Matthew J.