Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries
Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries
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DOI：
10.1377/hlthaff.2019.00838
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发表时间：
2019-12-01
期刊：
影响因子：
9.7
通讯作者：
Maddox, Karen E. Joynt
中科院分区：
文献类型：
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作者：
Johnston, Kenton J.;Wen, Hefei;Maddox, Karen E. Joynt
生活在农村地区的人的健康状况比城市居民差。了解造成这种情况的因素可以为减少城乡健康差距的政策干预提供信息。我们研究了一项具有全国代表性的调查，调查对象是患有一种或多种复杂慢性病的医疗保险受益人，占农村医疗保险受益人的61%和城市医疗保险受益人的57%。我们发现，与城市居民相比，农村居民的可预防住院率高出40%，死亡率高出23%。在我们控制了一次或多次初级保健提供者的访问后，在过去一年中进行一次或多次专家访问与慢性病患者的可预防住院率降低15.9%和死亡率降低16.6%相关。在可预防的住院和死亡率方面，获得专家服务的机会分别占城乡差异的55%和40%。医疗保险应考虑对无法获得专科护理的农村受益人进行干预，以减少城乡健康结果的差异。
People living in rural areas have worse health outcomes than their urban counterparts do. Understanding what factors account for this could inform policy interventions for reducing rural-urban disparities in health. We examined a nationally representative survey of Medicare beneficiaries with one or more complex chronic conditions, which represented 61 percent of rural and 57 percent of urban Medicare beneficiaries. We found that rural residence was associated with a 40 percent higher preventable hospitalization rate and a 23 percent higher mortality rate, compared to urban residence. Having one or more specialist visits during the previous year was associated with a 15.9 percent lower preventable hospitalization rate and a 16.6 percent lower mortality rate for people with chronic conditions, after we controlled for having one or more primary care provider visits. Access to specialists accounted for 55 percent and 40 percent of the rural-urban difference in preventable hospitalizations and mortality, respectively. Medicare should consider interventions for rural beneficiaries who lack access to specialist care to reduce rural-urban disparities in health outcomes.