Out-of-Pocket Spending for Influenza Hospitalizations in Medicare Advantage.
Out-of-Pocket Spending for Influenza Hospitalizations in Medicare Advantage.
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DOI：
10.1016/j.amepre.2020.11.004
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发表时间：
2021-04
影响因子：
5.5
通讯作者：
Conti RM
中科院分区：
文献类型：
--
作者：
Chua KP;Conti RM
尽管许多Medicare Advantage计划已免除COVID-19住院的费用分摊，但这些豁免是自愿的，可能是暂时的。为了估计如果不实施豁免或允许豁免到期，潜在患者费用分摊的幅度，本研究评估了2018年老年医疗保险优势患者中流感住院的自付支出水平和预测因素。使用Optum De-Identified Clinformatics DataMart，研究人员确定了2018年因流感住院的年龄≥65岁的Medicare Advantage患者。对于每次住院治疗，自付费用通过加总免赔额、共同保险和共同负担费用计算。计算平均自付费用和自付费用超过2,500美元的住院比例。拟合具有对数链接和泊松方差函数的单部分广义线性模型，以根据患者人口统计学特征、计划类型和住院特征对自付支出进行建模。通过计算平均边际效应，将系数转换为自付支出的绝对变化。在14，278例流感住院治疗中，平均自付费用为987美元（SD= 799美元）。3.0%的住院患者自付费用超过2，500美元。与自付费用较高相关的因素包括重症监护使用，住院时间更长，以及与HMO计划相比，参加首选提供者组织计划（平均边际效应= 634美元，95% CI= 631美元，636美元）。在这项对老年医疗保险优势患者的分析中，流感住院治疗的平均自付费用接近1000美元。联邦政策制定者应考虑通过立法，强制保险公司取消COVID-19住院费用分摊。目前享有费用分摊豁免的保险公司应考虑无限期延长豁免，没有豁免的保险公司应考虑立即执行豁免。
Although many Medicare Advantage plans have waived cost sharing for COVID-19 hospitalizations, these waivers are voluntary and may be temporary. To estimate the magnitude of potential patient cost sharing if waivers are not implemented or are allowed to expire, this study assesses the level and predictors of out-of-pocket spending for influenza hospitalizations in 2018 among elderly Medicare Advantage patients. Using the Optum De-Identified Clinformatics DataMart, investigators identified Medicare Advantage patients aged ≥65 years hospitalized for influenza in 2018. For each hospitalization, out-of-pocket spending was calculated by summing deductibles, coinsurance, and copays. The mean out-of-pocket spending and the proportion of hospitalizations with out-of-pocket spending exceeding $2,500 were calculated. A 1-part generalized linear model with a log link and Poisson variance function was fitted to model out-of-pocket spending as a function of patient demographic characteristics, plan type, and hospitalization characteristics. Coefficients were converted to absolute changes in out-of-pocket spending by calculating average marginal effects. Among 14,278 influenza hospitalizations, the mean out-of-pocket spending was $987 (SD=$799). Out-of-pocket spending exceeded $2,500 for 3.0% of hospitalizations. The factors associated with higher out-of-pocket spending included intensive care use, greater length of stay, and enrollment in a preferred provider organization plan (average marginal effect=$634, 95% CI=$631, $636) compared with enrollment in an HMO plan. In this analysis of elderly Medicare Advantage patients, the mean out-of-pocket spending for influenza hospitalizations was almost $1,000. Federal policymakers should consider passing legislation mandating insurers to eliminate cost sharing for COVID-19 hospitalizations. Insurers with existing cost-sharing waivers should consider extending them indefinitely, and those without such waivers should consider implementing them immediately.
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