Social Determinants of Health Influence Future Health Care Costs in the Medicaid Cohort of the District of Columbia Study.
Social Determinants of Health Influence Future Health Care Costs in the Medicaid Cohort of the District of Columbia Study.
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哥伦比亚特区研究的医疗补助队列中健康的社会决定因素影响未来的医疗保健费用。
DOI：
10.1111/1468-0009.12582
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Zeger,ScottL
中科院分区：
文献类型：
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作者：
McCarthy,MelissaL;Li,Yixuan;Elmi,Angelo;Wilder,MarceeE;Zheng,Zhaonian;Zeger,ScottL
健康的社会决定因素是未来医疗保健费用的重要预测因素。医疗补助必须与其他部门合作，以解决其受益人健康状况不佳和医疗保健支出高的根本原因。健康的社会决定因素是未来医疗保健费用的重要预测因素，但对它们对医疗补助支出的影响知之甚少。本研究分析了健康的社会决定因素（SDH）在预测未来的医疗保健费用的成人医疗补助受益人与类似的过去的发病率负担和过去的成本的作用。方法我们招募了8，892名成年医疗补助受益人参加前瞻性队列研究，他们在2017年9月至2018年12月31日期间在华盛顿两家医院附属的急诊科或诊所接受治疗。我们使用在登记时测量的SDH信息将参与者分为四个严重程度不断增加的社会风险类别。我们使用为期2年的医疗补助索赔;研究入组前和研究入组后12个月，根据调整后的临床组系统测量过去和未来的发病率负担。我们还使用医疗补助索赔数据来描述研究入组前一年和研究入组后一年的年度医疗补助总费用。8，892名参与者主要是女性（66%）和黑人（91%）。对于具有相似的过去疾病负担和过去成本的人（p< 0.01），与最低的社会风险等级相比，在较高的两个社会风险等级中的未来疾病负担显著更高（分别为1.15和2.04）。平均未来医疗保健支出是显着较高的社会风险类相比，最低的（分别为2，713、11，010和17，710），并且在两个社会风险最高的类别中，（分别为1，426和3，581），考虑到过去的发病负担和过去的成本（p<0.01）.以未来生育负担为对照，（与未来费用同时计量），社会风险等级不再是未来健康护理费用的显著预测因子。结论SD对未来健康护理负担和未来健康护理费用的预测具有显著意义。需要确定当前的支付系统是否能够充分考虑到高度医疗和社会复杂患者的医疗需求差异。
Policy Points Social determinants of health are an important predictor of future health care costs. Medicaid must partner with other sectors to address the underlying causes of its beneficiaries’ poor health and high health care spending. Context Social determinants of health are an important predictor of future health care costs but little is known about their impact on Medicaid spending. This study analyzes the role of social determinants of health (SDH) in predicting future health care costs for adult Medicaid beneficiaries with similar past morbidity burdens and past costs. Methods We enrolled into a prospective cohort study 8,892 adult Medicaid beneficiaries who presented for treatment at an emergency department or clinic affiliated with two hospitals in Washington, DC, between September 2017 and December 31, 2018. We used SDH information measured at enrollment to categorize our participants into four social risk classes of increasing severity. We used Medicaid claims for a 2‐year period; 12 months pre‐and post‐study enrollment to measure past and future morbidity burden according to the Adjusted Clinical Groups system. We also used the Medicaid claims data to characterize total annual Medicaid costs one year prior to and one year after study enrollment. Results The 8,892 participants were primarily female (66%) and Black (91%). For persons with similar past morbidity burdens and past costs (p< 0.01), the future morbidity burden was significantly higher in the upper two social risk classes (1.15 and 2.04, respectively) compared with the lowest one. Mean future health care spending was significantly higher in the upper social risk classes compared with the lowest one (2,713, 11,010, and 17,710,respectively)andremainedsignificantlyhigherforthetwohighestsocialriskclasses( 1,426 and 3,581,respectively),givenpastmorbidityburdenandpastcosts(p<0.01).Whenwecontrolledforfuturemorbidityburden(measuredconcurrentlywithfuturecosts),socialriskclasswasnolongerasignificantpredictoroffuturehealthcarecosts.ConclusionsSDHarestatisticallysignificantpredictorsoffuturemorbidityburdenandfuturecostscontrollingforpastmorbidityburdenandpastcosts.Furtherresearchisneededtodeterminewhethercurrentpaymentsystemsadequatelyaccountfordifferencesinthecareneedsofhighlymedicallyandsociallycomplexpatients.