Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013
Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013
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DOI：
10.1001/jama.2015.8035
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发表时间：
2015-07-28
影响因子：
120.7
通讯作者：
Wang, Yun
中科院分区：
文献类型：
--
作者：
Krumholz, Harlan M.;Nuti, Sudhakar V.;Wang, Yun
重要性在一个医疗保健技术、服务和行为发生动态变化的时期，跟踪健康和医疗保健的趋势可以提供一个关于正在实现的目标的视角。目的全面描述1999年至2013年期间医疗保险付费服务人群的死亡率、住院率和支出的全国趋势。和参与者使用Medicare分母和住院文件对1999年至2013年期间65岁或以上的Medicare受益人进行系列横断面分析。主要结果和指标对于所有Medicare受益人，全因死亡率趋势;对于按服务收费的受益人，全因住院的趋势以及与住院有关的结果和支出。地理变异，分层的关键人口群体，并在过去的1，3和6个月的生命中的收费服务受益人的护理强度的变化进行了assessed.RESULTS样本包括68 374 904独特的医疗保险受益人（收费服务和医疗保险优势）。所有医疗保险受益人的全因死亡率从1999年的5.30%下降到2013年的4.45%（差异为0.85个百分点; 95%CI为0.83-0.87）。在按服务收费的受益人中（n = 60 056 069），每10万人年的住院总人数从35 274人下降到26 930人（差异，8344; 95%CI，8315-8374）。平均通货膨胀调整住院费用每个医疗保险收费服务受益人从3290美元下降到2801美元（差异，489美元; 95%CI，487 - 490美元）。在生命最后6个月的付费服务受益人中，每100例死亡的住院人数从131.1人下降到102.9人（差异，28.2; 95%CI，27.9-28.4）。每100例死亡中有1次或1次以上住院治疗的受益人比例从70.5降至56.8（差异为13.7; 95%CI，13.5-13.8），而经通胀调整的每例死亡的住院费用从1999年的15 312美元增至2009年的17 423美元，然后降至2013年的13 388美元。结论和相关性在65岁或以上的医疗保险收费服务受益人中，全因死亡率，住院率和每位受益人的支出从1999年到2013年都有所下降。在生命的最后6个月，住院总人数和住院费用近年来有所下降。
IMPORTANCE In a period of dynamic change in health care technology, delivery, and behaviors, tracking trends in health and health care can provide a perspective on what is being achieved.OBJECTIVE To comprehensively describe national trends in mortality, hospitalizations, and expenditures in the Medicare fee-for-service population between 1999 and 2013.DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of Medicare beneficiaries aged 65 years or older between 1999 and 2013 using Medicare denominator and inpatient files.MAIN OUTCOMES AND MEASURES For all Medicare beneficiaries, trends in all-cause mortality; for fee-for-service beneficiaries, trends in all-cause hospitalization and hospitalization-associated outcomes and expenditures. Geographic variation, stratified by key demographic groups, and changes in the intensity of care for fee-for-service beneficiaries in the last 1, 3, and 6 months of life were also assessed.RESULTS The sample consisted of 68 374 904 unique Medicare beneficiaries (fee-for-service and Medicare Advantage). All-cause mortality for all Medicare beneficiaries declined from 5.30% in 1999 to 4.45% in 2013 (difference, 0.85 percentage points; 95% CI, 0.83-0.87). Among fee-for-service beneficiaries (n = 60 056 069), the total number of hospitalizations per 100 000 person-years decreased from 35 274 to 26 930 (difference, 8344; 95% CI, 8315-8374). Mean inflation-adjusted inpatient expenditures per Medicare fee-for-service beneficiary declined from $3290 to $2801 (difference, $489; 95% CI, $487-$490). Among fee-for-service beneficiaries in the last 6 months of life, the number of hospitalizations decreased from 131.1 to 102.9 per 100 deaths (difference, 28.2; 95% CI, 27.9-28.4). The percentage of beneficiaries with 1 or more hospitalizations decreased from 70.5 to 56.8 per 100 deaths (difference, 13.7; 95% CI, 13.5-13.8), while the inflation-adjusted inpatient expenditure per death increased from $15 312 in 1999 to $17 423 in 2009 and then decreased to $13 388 in 2013. Findings were consistent across geographic and demographic groups.CONCLUSIONS AND RELEVANCE Among Medicare fee-for-service beneficiaries aged 65 years or older, all-cause mortality rates, hospitalization rates, and expenditures per beneficiary decreased from 1999 to 2013. In the last 6 months of life, total hospitalizations and inpatient expenditures decreased in recent years.