The costs of children with sickle cell anemia: Preparing for managed care
The costs of children with sickle cell anemia: Preparing for managed care
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DOI：
10.1097/00043426-199811000-00003
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发表时间：
1998-11-01
影响因子：
1.2
通讯作者：
Anderson, GF
中科院分区：
文献类型：
--
作者：
Bilenker, JH;Weller, WE;Anderson, GF
目的：预测在按人头管理的管理医疗安排下，照顾镰状细胞性贫血 (SCA) 等慢性病儿童的医生和管理医疗组织所面临的临床挑战和财务风险。患者和方法：一项基于华盛顿州医疗补助计划 (WSMP) 和联邦雇员健康福利计划 (FEP) 的索赔数据的横断面研究。将 1993 财年 (FY1993) 期间在华盛顿州或由 FEP 在 1992 财年提交并支付诊断为 SCA 的 18 岁或以下儿童的支出模式与所有儿童的支出模式进行比较。结果：患有 SCA 的儿童的平均支出是 WSMP 中所有儿童平均支出的 8.8 倍。患有 SCA 的儿童的年度支出差异很大；最贵的10%儿童占总支出的56%。 97% 的支出集中在四大类：72% 用于住院护理，11% 用于门诊护理，11% 用于医生付款，3% 用于处方药。对参加 FEP 的镰状细胞性贫血儿童的支出和利用模式进行的检查得出了类似的结果。结论：除非管理式医疗组织和按人头计额的儿科医生获得的支付率反映了照顾这些儿童的较高预期支出，否则获得护理的机会和质量可能会受到影响。对实践指南和利用模式的分析表明，新生儿筛查、定期使用专业设施和综合教育计划是很容易因按人头付费而减少的关键领域。
Purpose: To anticipate the clinical challenges and financial risks facing physicians and managed care organizations who care for children with chronic illnesses, such as sickle cell anemia (SCA), under capitated managed care arrangements.Patients and Methods: A cross-sectional study based on claims data from the Washington State Medicaid Program (WSMP) and the Federal Employees Health Benefits Program (FEP). Expenditure patterns were compared for children 18 years of age or younger for whom a claim with a diagnosis of SCA was submitted and paid in the State of Washington during fiscal year 1993 (FY1993) or by the FEP during FY1992 to expenditure patterns for all children.Results: Children with SCA had mean expenditures 8.8 times the mean expenditures for all children in WSMP. There was wide variation in the annual expenditures among children with SCA; the most expensive 10% of children accounted for 56% of total expenditures. Ninety-seven percent of the expenditures were concentrated in four broad categories: 72% for inpatient care, 11% for outpatient care, 11% for physician payments, and 3% for prescription drugs. Examination of expenditure and utilization patterns for children with sickle cell anemia enrolled in the FEP yielded similar results.Conclusions: Unless managed care organizations and capitated pediatricians receive payment rates that reflect the higher expected expenditures of caring for these children, access to and quality of care may suffer. Analyses of practice guidelines and utilization patterns suggest that newborn screening, regular access to specialty facilities, and comprehensive education programs are critical areas that are vulnerable to reductions under capitation.