Hospice effect on government expenditures among nursing home residents
Hospice effect on government expenditures among nursing home residents
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DOI：
10.1111/j.1475-6773.2007.00746.x
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发表时间：
2008-02-01
影响因子：
3.4
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
--
作者：
Gozalo, Pedro L.;Miller, Susan C.;Mor, Vincent
目标。检验联邦医疗保险临终关怀福利对符合双重资格的联邦医疗保险-医疗补助养老院(NH)居民的医疗保险和医疗补助支出的影响。数据来源/研究背景。1998-1999年全国居民二次资料研究设计。1999年7月至12月期间死亡的佛罗里达州NH居民的回顾性队列研究(N=5,774)。Medicare索赔确定了临终关怀登记人数，Medicare和Medicaid索赔按护理类别确定了支出。养老院住院医师评估用于对照病例组合的差异。使用疗养院、临终关怀提供者和医院的地理编码来识别和描述当地医疗保健市场。数据收集/提取方法。构建了一个文件，将Medicare和Medicaid索赔与NH居民的最低数据集评估以及NH Provider(在线调查和认证自动化记录)和临终关怀提供者文件联系起来。主要调查结果。在所有短期(90天)垂死的NH居民中，临终关怀为癌症居民节省了一些费用(8%)，而在痴呆症居民中，临终关怀服务的成本是中性的，并为确诊为癌症或痴呆症以外的居民增加了一些费用(10%)。有证据表明，选择存在偏见，特别是在患有癌症的居民中(未调整的储蓄为19%，调整后的储蓄为8%)。在短期入住的NH居民中，临终关怀大大减少了医疗保险支出，但增加了医疗补助支出。参加临终关怀会导致生命最后一个月的医疗保险/医疗补助综合支出较低，特别是在短期居住的NH居民中。然而，这种影响因诊断和NH住院时间而异。此外，对于短期入住的NH居民，目前的支付政策创造了医疗保险激励和医疗补助抑制，以促进居民转介到临终关怀。
Objective. To examine the effect of the Medicare hospice benefit on Medicare and Medicaid expenditures by dual-eligible Medicare-Medicaid nursing home (NH) residents.Data Sources/Study Setting. Secondary data for NH residents for 1998-1999.Study Design. Retrospective cohort study of NH residents in the state of Florida who died between July and December 1999 (N=5,774). Medicare claims identified hospice enrollment, and Medicare and Medicaid claims identified expenditures by categories of care. Nursing home resident assessments were used to control for case-mix differences. Geocoding of nursing homes, hospice providers and hospitals was used to identify and characterize local health care markets.Data Collection/Extraction Methods. A file was constructed linking Medicare and Medicaid claims to Minimum Data Set assessments of NH residents, and NH provider (Online Survey and Certification Automated Record) and hospice provider files.Principal Findings. Hospice enrollment results in substantial savings in government expenditures (22 percent) among all short-stay ( 90 days) dying NH residents, hospice provides some savings (8 percent) among cancer residents while it is cost-neutral among dementia residents and adds some cost (10 percent) for residents with a diagnosis other than cancer or dementia. There is evidence of selection bias, particularly among residents with cancer (19 percent savings unadjusted versus 8 percent adjusted). Among short-stay NH residents, hospice greatly reduces Medicare expenditures but increases Medicaid expenditures.Conclusions. Hospice enrollment results in lower combined Medicare/Medicaid expenditures in the last month of life, particularly among short-stay NH residents. This effect, however, varies by diagnosis and NH length of stay. In addition, for short-stay NH residents, current payment policy creates a Medicare incentive and Medicaid disincentive for promoting residents' referral to hospice.