Discontinuity of Medicaid Coverage Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression
Discontinuity of Medicaid Coverage Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression
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DOI：
10.1097/mlr.0000000000000751
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发表时间：
2017-08-01
期刊：
影响因子：
3
通讯作者：
Cummings, Janet R.
中科院分区：
文献类型：
--
作者：
Ji, Xu;Wilk, Adam S.;Cummings, Janet R.
背景：医疗补助覆盖范围的差距可能会影响护理的获取和连续性。这对于患有重度抑郁症等慢性病的受益人来说可能是有害的，对他们来说，门诊护理的中断可能会导致他们更多地使用急性护理。然而，人们对医疗补助覆盖范围的不连续性如何影响患有抑郁症的成人的急性护理利用情况知之甚少。目的：检查医疗补助不连续性与患有重度抑郁症的成人中的服务利用之间的关系。受试者：使用 2003-2004 年医疗补助分析提取文件，总共识别出 139,164 名患有重度抑郁症的成年人（18-64 岁）。方法：我们使用广义线性和两部分模型来检查医疗补助对服务利用的中断。为了确定这种关系中的因果关系，我们使用了工具变量分析，依靠州级政策中的外生变化进行识别。结果衡量标准：急诊科 (ED) 就诊次数、住院次数、住院天数和医疗补助报销费用。结果：大约 29.4% 的受益人经历了承保中断。在工具变量模型中，与连续承保的人相比，承保中断的人每个医疗补助承保月的每人急症护理费用增加了 650 美元，这可以从急诊室使用率的增加（每人每月急诊就诊次数增加 0.1 次）和住院天数（每人每月增加 0.6 天）证明。急性费用的增加导致每人每月的全因费用总体增加了 310 美元（所有 P 值 < 0.001）。结论：在抑郁症成年人中，平均而言，那些经历承保中断的人比那些连续承保的人更多地使用昂贵的急诊/住院服务。维持持续的医疗补助覆盖可能有助于预防需要高成本干预的急性发作。
Background: Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression.Objective: Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression.Subjects: A total of 139,164 adults (18-64) with major depression was identified using the 2003-2004 Medicaid Analytic eXtract Files.Methods: We used generalized linear and two-part models to examine the effect of Medicaid discontinuity on service utilization. To establish causality in this relationship, we used instrumental variables analysis, relying on exogenous variation in a state-level policy for identification.Outcome Measures: Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs.Results: Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-values < 0.001).Conclusions: Among depressed adults, those experiencing coverage disruptions have, on average, significantly greater use of costly ED/inpatient services than those with continuous coverage. Maintenance of continuous Medicaid coverage may help prevent acute episodes requiring high-cost interventions.