Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care-Sensitive Conditions
Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care-Sensitive Conditions
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DOI：
10.7326/0003-4819-149-12-200812160-00004
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发表时间：
2008-12-16
影响因子：
39.2
通讯作者：
Auerback, Glenna M.
中科院分区：
文献类型：
--
作者：
Bindman, Andrew B.;Chattopadhyay, Arpita;Auerback, Glenna M.
背景：许多低收入的美国公民经历了医疗保险的中断。目的：确定医疗补助受益人中门诊护理敏感条件的住院率。设计：回顾性队列研究。环境：加州医疗补助人口。患者：4735797名18到64岁的加州成年人，他们在1998年到2002年间接受了至少一个月的医疗补助。测量：门诊护理敏感条件的住院时间。结果：62%的医疗补助受益人在研究期间至少经历过一次保险中断。导致住院的3种最常见的对门诊护理敏感的疾病是心力衰竭、糖尿病和慢性阻塞性肺病。覆盖中断与门诊敏感疾病住院的高风险相关（调整后的风险比为3.66 [95% CI, 3.59 ~ 3.72]; P < 0.001）。在亚组分析中，通过贫困家庭临时援助计划（调整后的风险比，8.56 [CI， 8.06至9.08]）获得保险覆盖中断与住院治疗之间的关联强于通过补充保障收入计划（调整后的风险比，1.72 [CI， 1.67至1.76]）获得保险覆盖中断的受益人，后者通常在医疗补助计划被中断时仍保留医疗保险。局限性：该研究缺乏关于中断发生的原因以及中断的受益人是否转移到其他保险范围的信息。结论：医疗补助覆盖的中断与门诊护理敏感条件的住院率较高有关。减少医疗补助中断频率的政策可能会防止一些引发住院治疗和高成本医疗支出的健康事件。
Background: Many low-income U.S. citizens experience interruptions in health insurance coverage.Objective: To determine the rate of hospitalization for ambulatory care-sensitive conditions among Medicaid beneficiaries with interruptions in coverage.Design: Retrospective cohort study.Setting: California Medicaid population.Patients: 4 735 797 adults in California age 18 to 64 years who received a minimum of 1 month of Medicaid coverage between 1998 to 2002.Measurement: Time to hospitalization for an ambulatory care sensitive condition.Results: Sixty-two percent of Medicaid beneficiaries experienced at least 1 interruption in coverage during the study period. The 3 most common ambulatory care-sensitive conditions resulting in a hospitalization were heart failure, diabetes, and chronic obstructive pulmonary disease. Interruptions in coverage were associated with a higher risk for hospitalization for an ambulatory care-sensitive condition (adjusted hazard ratio, 3.66 [95% CI, 3.59 to 3.72]; P < 0.001). In subgroup analyses, the association between interrupted coverage and hospitalization was stronger for beneficiaries eligible through the Temporary Aid to Needy Families program (adjusted hazard ratio, 8.56 [CI, 8.06 to 9.08]) than for beneficiaries eligible through the Supplemental Security Income program (adjusted hazard ratio, 1.72 [CI, 1.67 to 1.76]), who typically retain Medicare coverage even when their Medicaid coverage is interrupted.Limitation: The study lacked information on why interruptions occurred and whether beneficiaries with interruptions transitioned to other insurance coverage.Conclusion: Interruptions in Medicaid coverage are associated with a higher rate of hospitalization for ambulatory care-sensitive conditions. Policies that reduce the frequency of interruptions in Medicaid coverage might prevent some of the health events that trigger hospitalization and high-cost health care spending.