The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness.
The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness.
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DOI：
10.1097/mlr.0000000000000572
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发表时间：
2016-09
期刊：
影响因子：
3
通讯作者：
Soumerai SB
中科院分区：
文献类型：
--
作者：
Burns ME;Huskamp HA;Smith JC;Madden JM;Soumerai SB
从仅医疗补助到医疗保险/医疗补助双重覆盖的过渡有可能通过增加覆盖范围或扩大对临床医生的访问来减少严重精神疾病患者（SMI）医疗保健的财务障碍。估计双重覆盖的影响后，医疗补助登记在所需的等待期内的成年人与SMI对医疗保健的使用，整体和相关的精神健康和物质使用障碍（MHSUD）。数据包括2004年1月至2007年12月在密苏里州（MO）和南卡罗来纳州（SC）的医疗补助和医疗保险的登记和索赔。我们采用中断时间序列设计来评估双重覆盖对门诊、急诊（艾德）和住院护理/月平均使用的影响。双重保险实施12个月后，这两个州的门诊护理使用概率均从4 - 9%增加。在MO中，总的和MHSUD相关的艾德就诊的平均概率和频率增加了21-32%;全因和MHSUD相关住院的概率分别增加了10%和19%。在SC中，任何住院的平均概率增加了27%，任何MHSUD相关住院的平均概率增加了42%。门诊治疗使用率的增加与双重保险下门诊服务的覆盖率和支付费用的预期增加相一致。持续增加的艾德和住院病人提出的问题，获得护理的复杂性下2计划，被压抑的需求之间的受益人过渡前，门诊和住院服务的互补性使用。
The transition from Medicaid-only to dual Medicare/Medicaid coverage has the potential to reduce financial barriers to health care for patients with serious mental illness (SMI) through increased coverage or expanded access to clinicians as their reimbursement increases. To estimate the effect of dual coverage after Medicaid enrollment during the required waiting period among adults with SMI on health care use, overall and related to mental health and substance use disorders (MHSUD). Data include enrollment and claims from Medicaid and Medicare in Missouri (MO) and South Carolina (SC), from January 2004 – December 2007. We used an interrupted time series design to estimate the effect of dual coverage on average use of outpatient, emergency (ED), and inpatient care/month. After 12-months of dual coverage, the probability of outpatient care use increased in both states from 4 – 9%. In MO the mean probability and frequency of ED visits, total and MHSUD-related, increased by 21–32%; the probability of all-cause and MHSUD-related inpatient admissions increased by 10% and 19% respectively. In SC, the mean probability of any inpatient admission increased by 27% and of any MHSUD-related inpatient admission by 42%. The increase in use of outpatient care is consistent with the expected increase in coverage of, and payment for, outpatient services under dual coverage relative to Medicaid-only. Sustained increases in ED and inpatient admissions raise questions regarding the complexity of obtaining care under 2 programs, pent-up demand among beneficiaries pre-transition, and the complementarity of outpatient and inpatient service use.