Medicare and Private Insurance Variations in New Medical Technology: The Case of Drug Eluting Stents
Medicare and Private Insurance Variations in New Medical Technology: The Case of Drug Eluting Stents
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新医疗技术中医疗保险和私人保险的变化：药物洗脱支架的案例
DOI：
10.4172/2471-268x.1000114
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
P. K. Mandic
中科院分区：
文献类型：
--
作者：
E. E. Bayindir;P. K. Mandic
重要性很少有人知道的地理和医院的变化，新的医疗技术在医疗保险。对私人保险人的这些变化所知更少。目的比较医疗保险和私人保险人群，研究药物洗脱支架扩散的地理和医院差异。设计回顾性分析11个州（2004 - 2005年）的州住院患者数据库中的出院病例，并补充美国医院协会年度调查中的医院特征数据。背景/参与者研究样本包括涉及心脏支架的经皮冠状动脉介入治疗（PCI）手术的出院病例。风险暴露保险类型：医疗保险与私人保险。主要结果PCI期间药物洗脱支架的使用是我们的结果变量。我们估计线性概率模型在出院水平，我们的结果变量相关的患者和医院的特点分别为医疗保险和私人保险。为了检查医院转诊区域（HRR）和医院之间的差异，我们的模型分别包括HRR和医院指标。我们的分析包括390，649条记录（237，991份医疗保险，152，658份私人保险）。我们发现，2004年，在药物洗脱支架获批后的第二年，两种付款人类型的药物洗脱支架使用的HRR差异很大（调整后的CoV：0.35（医疗保险）; 0.24（私人保险））。2004年，我们还发现了较大的医院差异（调整后的CoV：0.32（医疗保险）; 0.29（私人保险））。在2004年和2005年之间，调整后的HRR和医院的变化在两种支付者类型中都有所下降，这表明随着药物洗脱支架的普及和变得更加普遍，实践风格趋于一致。最后，调整后的药物洗脱支架率在HRR和医院水平上与支付者类型高度相关。结论我们的研究结果是一致的假设，私人保险密切跟随医疗保险的医疗技术覆盖和报销方面的领先地位。
Importance Little is known about the geographic and hospital variations of the new medical technologies in Medicare. Even less is known about these variations for the privately insured. Objective To examine geographic and hospital variations in the diffusion of drug eluting stents, comparing Medicare and privately insured populations. Design Retrospective analyses of discharges from the State Inpatient Databases for 11 states (2004–2005) supplemented with data on hospital characteristics from the American Hospital Association Annual Survey. Setting/participants Study sample included discharges with percutaneous coronary intervention (PCI) procedures that involved a cardiac stent. Exposure Insurance type: Medicare versus private insurance. Main outcome Use of a drug eluting stent during the PCI was our outcome variable. We estimated linear probability models at the discharge level that related our outcome variable to patient and hospital characteristics separately for Medicare and private insurance. To examine variations across hospital referral regions (HRRs) and across hospitals, our models included HRR and hospital indicators respectively. Results Our analysis included 390,649 records (237,991 Medicare, 152,658 private insurance). We found large HRR variations in the use of drug eluting stents in 2004 for both payer types, the year after drug eluting stents were approved (adjusted CoV: 0.35 (Medicare); 0.24 (Private Insurance)). We also found large hospital variations in 2004 (adjusted CoV: 0.32 (Medicare); 0.29 (Private Insurance)). Between 2004 and 2005, adjusted HRR and hospital variations decreased across both payer types, suggesting that practice styles converged as the drug eluting stents diffused and became more common. Finally, adjusted drug eluting stent rates were highly correlated both at the HRR and hospital level across payer types. Conclusion Our findings are consistent with the hypothesis that private insurance closely follows the lead of Medicare in terms of medical technology coverage and reimbursement.
影响因子：
9.7
作者：
Baicker, K;Chandra, A
通讯作者：
Chandra, A
影响因子：
9.7
作者：
Fisher, ES;Wennberg, DE;Gottlleb, DJ
通讯作者：
Gottlleb, DJ