Payer Type and Low-Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations
Payer Type and Low-Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations
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DOI：
10.1111/1475-6773.12665
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发表时间：
2018-04-01
影响因子：
3.4
通讯作者：
Rosenthal, Meredith B.
中科院分区：
文献类型：
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作者：
Colla, Carrie H.;Morden, Nancy E.;Rosenthal, Meredith B.
目的比较商业保险和医疗保险人群对低价值医疗服务的使用，并探讨支付者类型对提供低价值医疗服务的影响。数据来源2009 -2011年全国医疗保险和商业保险管理数据。设计我们创建了基于索赔的算法来测量七个选择明智识别的低价值医疗服务，价值服务，并研究了商业和医疗保险过度使用之间的相关性，在整体和区域一级。回归模型探讨了过度使用和区域特征之间的关联。MethodsWe创建了背痛的早期成像，维生素D筛查，65岁以上宫颈癌筛查，偏头痛的处方阿片类药物使用，无症状患者的心脏测试，短间隔重复骨密度测定（DXA），低风险手术的术前心脏测试，主要发现四种服务的患病率在保险定义的群体中是相似的。医疗保险和商业过度使用之间的区域相关性很高（相关系数=0.540-0.905）的所有措施。在这两个组中，类似的区域水平的因素与低价值的医疗服务提供，特别是总的医疗保险支出和比例的专家，初级保健physics.ConclusionsLow-value护理出现驱动无关的因素付款人类型或预期的报销。这些发现表明，当地实践模式对护理的影响不会因支付者类型而产生有意义的歧视。
ObjectiveTo compare low-value health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of low-value care.Data Sources2009-2011 national Medicare and commercial insurance administrative data.DesignWe created claims-based algorithms to measure seven Choosing Wisely-identified low-value services and examined the correlation between commercial and Medicare overuse overall and at the regional level. Regression models explored associations between overuse and regional characteristics.MethodsWe created measures of early imaging for back pain, vitamin D screening, cervical cancer screening over age 65, prescription opioid use for migraines, cardiac testing in asymptomatic patients, short-interval repeat bone densitometry (DXA), preoperative cardiac testing for low-risk surgery, and a composite of these.Principal FindingsPrevalence of four services was similar across the insurance-defined groups. Regional correlation between Medicare and commercial overuse was high (correlation coefficient=0.540-0.905) for all measures. In both groups, similar region-level factors were associated with low-value care provision, especially total Medicare spending and ratio of specialists to primary care physicians.ConclusionsLow-value care appears driven by factors unrelated to payer type or anticipated reimbursement. These findings suggest the influence of local practice patterns on care without meaningful discrimination by payer type.