Differences in the Receipt of Low-Value Services Between Publicly and Privately Insured Children
Differences in the Receipt of Low-Value Services Between Publicly and Privately Insured Children
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DOI：
10.1542/peds.2019-2325
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发表时间：
2020-02-01
期刊：
影响因子：
8
通讯作者：
Huang, Elbert S.
中科院分区：
文献类型：
--
作者：
Chua, Kao-Ping;Schwartz, Aaron L.;Huang, Elbert S.
背景：儿童经常接受没有改善健康的低价值服务，但尚不清楚公立和私立保险儿童接受这些服务的情况是否不同。方法：我们分析了2013-2014年Medicaid Analytic eXtract和IBM MarketScan商业索赔和遭遇数据库。使用20项低价值医疗措施（6项诊断测试措施，5项成像措施和9项处方药措施），我们比较了2014年12个州至少一次或两次接受低价值服务的公立和私立保险儿童的比例；参加公共和私人保险的儿童至少接受一次低价值诊断检查、影像学检查和处方药的比例；以及每项措施中至少接受过一次服务的公立和私立保险儿童的比例。结果：在6 951 556名公立参保儿童和1 647 946名私立参保儿童中，分别有11.0%和8.9%的儿童至少接受过一次低值服务，3.9%和2.8%的儿童至少接受过两次低值服务，3.2%和3.8%的儿童至少接受过一次低值诊断检查，0.4%和0.4%的儿童至少接受过一次低值影像学检查，8.4%和5.5%的儿童至少接受过一次低值处方药服务。接受每项服务的合格儿童比例的差异通常很小（20项措施的中位数差异，公共减去私人：+0.3个百分点）。结论：2014年，每9名公立参保儿童和每11名私立参保儿童中就有1名接受了低价值服务。总体而言，人群之间的差异不大，这表明浪费的护理与付款人类型没有高度关联。减少这种护理的努力应针对所有人群，无论付款人构成如何。公共和私人保险的儿童经常接受低价值的服务，人口之间的差异很小。
BACKGROUND: Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. METHODS: We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. RESULTS: Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). CONCLUSIONS: In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.Both publicly and privately insured children frequently receive low-value services, and differences between populations are small.