Older Adults and Specialty Care Use in Managed Care

管理医疗组织(MCO)一直是对医疗成本控制困境的一种回应。最近对急性中风患者的研究表明，管理型护理患者接受住院专门护理的可能性低于收费服务(FFS)患者，但仅限于老年患者。这种年龄差异引发了一个有争议的问题：在MCO中实行基于年龄的配给的可能性。随着对管理性医疗资源管理战略的讨论变得越来越两极分化，对这些发现的后续研究至关重要。随着医疗保健市场的发展，更新我们对MCO如何管理医疗保健的理解是很重要的，特别是对最脆弱的人群。然而，对于急性中风患者，大部分管理都是在医院层面进行的。该项目的长期目标是研究MCO激励机制和医院特征在解释老年急性中风住院患者的专科护理使用(包括年龄梯度)、结果和费用方面的差异。拟议的研究将确定1997-2000年期间因急性缺血性中风而出院的65岁及以上的联邦医疗保险受益人，使用来自大型国家MCO的健康计划的索赔数据，以及来自同一大都市地区的FFS联邦医疗保险受益人的比较样本。管理数据将用于获取有关特定MCO激励措施的信息，包括医院和医生支付政策、医院网络和利用审查。这一点将通过美国医院协会年度调查中关于医院特征的数据得到加强，包括医院的专业化水平和管理医疗经验。有关当地环境的信息将从区域资源文件中获得。多水平建模技术将被用来分离MCO、医院和患者在解释特殊护理使用、成本和结果的差异方面的影响。这项拟议的研究将为临床医生、政策制定者和研究人员提供有价值的信息，他们对管理式护理和卫生保健提供者(即医院)对急性疾病老年患者的影响感兴趣。

Managed care organizations (MCOs) have been one response to the health care cost-containment dilemma. Recent research on acute stroke patients has shown that managed care patients had a lower probability of receiving in-hospital specialty care than patients in fee-for-service (FFS), but only among older patients. This age gradient raises a contentious issue: the possibility of age-based rationing in MCOs. Follow-up research on such findings is crucial as discussions of managed care resource management strategies become increasingly polarized. As the health care market evolves it is important to update our understanding of how MCOs manage care, especially for the most vulnerable populations. However, for acute stroke patients, much of the management goes on at the hospital level. The long-term objective of this project is to examine the contribution of both MCO incentives and hospital characteristics in explaining variation in specialty care use (including the age gradient), outcomes, and costs for older patients who are hospitalized with acute stroke. The proposed research will identify Medicare beneficiaries 65 years of age and older discharged with acute ischemic stroke during 1997-2000 using claims data from health plans that are part of a large national MCO, and a comparison sample of FFS Medicare beneficiaries from the same metropolitan areas. Administrative data will be used to obtain information on specific MCO incentives, including hospital and physician payment policies, hospital networks, and utilization review. This will be augmented by data on hospital characteristics from the American Hospital Association annual surveys, including the hospital's level of specialization and experience with managed care. Information on the local environment will be obtained from the Area Resource File. Multilevel modeling techniques will be used to separate the effects of MCOs, hospitals and patients in explaining variation in specialty care use, costs and outcomes. The proposed research will provide valuable information to clinicians, policymakers and researchers interested in the effects of managed care and health care providers (i.e., hospitals) on acutely-ill older patients.