Utilization trends for advanced imaging procedures - Evidence from individuals with private insurance coverage in California
Utilization trends for advanced imaging procedures - Evidence from individuals with private insurance coverage in California
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DOI：
10.1097/mlr.0b013e31815dc5ae
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发表时间：
2008-05-01
期刊：
影响因子：
3
通讯作者：
Mitchell, Jean M.
中科院分区：
文献类型：
--
作者：
Mitchell, Jean M.
背景资料：医疗保险支付咨询委员会最近的报告强调了医疗保险收费服务人群中先进诊断成像程序的使用急剧增加。很少有研究探讨这种趋势是否也存在于私人保险覆盖面很广的人群中。此外，研究记录的变化与自我referreration.Research设计：使用数据从一个大型私人保险公司在加州，我们记录的趋势，利用磁共振成像（MRI），计算机断层扫描（CT），正电子发射断层扫描（PET）扫描在2000年至2004年的时间段。我们收集的数据使我们能够按提供者类型（自我转诊医生、放射科医生、医院和独立诊断检测机构）计算使用率的相对变化。检查的趋势，在供应商类型进行的利用率的份额可以提供见解的影响，自我转介率use.Results：使用率为3个先进的成像方式检查MRI，CT，PET-2000年和2004年之间迅速增加。PET利用率增加了近400%，而MRI和CT的相应增加超过50%。研究结果表明，医生自我转诊安排和独立的诊断检测设施似乎有助于这种先进的成像，特别是MRI和PET的更多使用。相比之下，在医院进行的先进成像使用的相对变化很小。所有3种方式的使用率在加州南部比在该州的北方地区高得多。结论：使用高报销的先进成像，一个主要的驱动程序较高的医疗保健费用，应根据明确的临床实践指南，以确保适当的使用。
Background: Recent reports by the Medicare Payment Advisory Commission have highlighted sharp increases in the use of advanced diagnostic imaging procedures among the Medicare fee-for-service population. Little research has examined whether such trends also exist among persons with generous private insurance coverage. Moreover, research documenting changes in the share of utilization linked to self-referral is nonexistent.Research Design: Using data from a large private insurer in California, we document trends in utilization for magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scans over the time period 2000-2004. We collected data that enable us to calculate relative changes in use rates by provider type (self-referral physicians, radiologists, hospitals, and independent diagnostic testing facilities). Examining trends in the share of utilization performed by provider type can offer insights as to the effects of self-referral on rates of use.Results: Rates of use for the 3 advanced imaging modalities examined-MRI, CT, and PET-increased rapidly between 2000 and 2004. PET utilization increased by almost 400%, whereas the corresponding increases for MRI and CT exceeded 50%. Findings suggest that physician self-referral arrangements and independent diagnostic testing facilities seem to be contributing to this greater use of advanced imaging, especially for MRI and PET. In contrast, relative changes in use of advanced imaging performed at hospitals were small. Use rates for all 3 modalities were much higher in southern California compared with the northern region of the state.Conclusions: Use of highly reimbursed advanced imaging, a major driver of higher health care costs, should be based on clear clinical practice guidelines to ensure appropriate use.