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A DETAILED PROFILE OF THE END-OF-LIFE CARE IN MEDICARE

医疗保险中临终关怀的详细概况

基本信息

批准号：
6337256
负责人：
DORCAS JOANNE LYNN
金额：
$ 31.39万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-09-30 至 2002-09-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6337256
关键词：
Medicare /Medicaid chronic obstructive pulmonary disease clinical research congestive heart failure dementia health care cost /financing health care service evaluation health insurance health services research tag human mortality human subject neoplasm /cancer

项目摘要

The objectives of this proposed study are: 1. To document in detail the cost and patterns of end-of-life care for Medicare beneficiaries within five broad categories (cancers, dementia, congestive heart failure, chronic obstructive pulmonary disease, all other deaths). 2. To examine the geographic variations in cost and patterns of care within these categories, and determine the factors associated with variation in cost and patterns of care for these diseases. 3. To demonstrate methods for prospectively identifying cohorts of beneficiaries likely to be nearing end of life, and to calculate prospective capitation rates for these cohorts. The overall goal of this work is to obtain basic research needed to reshape Medicare payment policy for end-of-life care. Medicare's fractured fee-for-service payment discourages integrated management of end stage disease and encourages acute over palliative treatment. Integrated payment approaches (per diem, capitation, or other) have greater potential to encourage delivery of appropriate and compassionate end-of-life care. Restructuring Medicare policy toward more integrated payment requires identifying individuals likely to benefit from special end-of-life care, determining services and providers to be covered under an integrated payment, calculating Medicare's average cost for those services, and analyzing variation around that average cost. The proposed research will provide detailed data needed to discuss options for restructuring Medicare payment for end-of-life care. We propose a combination of descriptive analysis and hypothesis testing. First, because so little detailed information is available, we propose to create a databook on Medicare end-of- life care, a comprehensive profile of cost and use. Descriptive analyses will be guided by a National Advisory Board of experts in end-of-life care, with a goal of developing a useful reference on Medicare-financed end-of-life care. Second, we will test specific hypotheses regarding cost and use.

本拟议研究的目标是： 1. 详细记录 Medicare 受益人五大类（癌症、痴呆、充血性心力衰竭、慢性阻塞性肺病、所有其他死亡）的临终关怀费用和模式。 2. 检查这些类别内费用和护理模式的地理差异，并确定与这些疾病的费用和护理模式变化相关的因素。 3. 展示前瞻性识别可能接近生命尽头的受益人群体的方法，并计算这些群体的预期按人头付费率。这项工作的总体目标是获得重塑临终关怀医疗保险支付政策所需的基础研究。医疗保险按服务收费的分散方式不利于对终末期疾病的综合管理，并鼓励急性过度姑息治疗。综合支付方式（按日付费、按人头付费或其他）更有潜力鼓励提供适当和富有同情心的临终关怀。将医疗保险政策调整为更加综合的支付，需要确定可能从特殊临终护理中受益的个人，确定综合支付所涵盖的服务和提供者，计算医疗保险这些服务的平均成本，并分析该平均成本的变化。拟议的研究将提供讨论重组临终关怀医疗保险支付方案所需的详细数据。我们建议结合描述性分析和假设检验。首先，由于可用的详细信息很少，我们建议创建一本关于医疗保险临终关怀的数据手册，全面介绍成本和使用情况。描述性分析将由国家临终关怀专家咨询委员会指导，目标是为医疗保险资助的临终关怀提供有用的参考。其次，我们将测试有关成本和使用的具体假设。