Use of high-cost operative procedures by medicare beneficiaries enrolled in for-profit and not-for-profit health plans
Use of high-cost operative procedures by medicare beneficiaries enrolled in for-profit and not-for-profit health plans
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DOI：
10.1056/nejmsa035634
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发表时间：
2004-01-08
影响因子：
158.5
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Schneider, EC;Zaslavsky, AM;Epstein, AM
背景：人们普遍认为，营利性健康计划比非营利性健康计划更有可能通过限制获得护理，特别是获得高成本程序来应对经济激励。直到最近，数据来解决这个问题一直limited.Methods：我们测试的假设，即使用率的12个常见的高成本的程序将是较低的营利性的健康计划比在不以营利为目的的计划。使用1997年期间参加254个健康计划的3，726，065名65岁或以上的医疗保险受益人的标准化医疗保险HEDIS数据，我们比较了营利性和非营利性计划的心导管插入术，冠状动脉旁路移植术，经皮腔内冠状动脉成形术，颈动脉内膜切除术，股骨骨折复位术，全髋关节置换术，全膝关节置换术、部分结肠切除术、开腹胆囊切除术、闭合胆囊切除术、子宫切除术和直肠切除术。我们调整了比较社会人口的情况下组合和健康计划的特点，而不是他们的税收状况，包括计划的location.Results：颈动脉内膜切除术，心导管插入术，冠状动脉旁路移植术，经皮冠状动脉腔内成形术的比率高于营利性健康计划比他们在不以营利为目的的健康计划;其他常见的昂贵的手术程序的使用率是相似的两种类型的计划。在对登记者的病例组合和计划的其他特征进行调整后，在我们研究的12个程序中，营利性计划的费率明显高于非营利计划的费率，而没有一个程序的费率较低。健康计划的地理位置并没有解释这些findings.Conclusions：相反，我们的期望可能产生的影响，财政激励措施，高成本的手术程序的使用率并不低于受益人参加营利性的健康计划比那些参加非营利的健康计划。
Background:It is widely believed that for-profit health plans are more likely than not-for-profit health plans to respond to financial incentives by restricting access to care, especially access to high-cost procedures. Until recently, data to address this question have been limited.Methods:We tested the hypothesis that the rates of use of 12 common high-cost procedures would be lower in for-profit health plans than in not-for-profit plans. Using standardized Medicare HEDIS data on 3,726,065 Medicare beneficiaries 65 years of age or older who were enrolled in 254 health plans during 1997, we compared for-profit and not-for-profit plans with respect to rates of cardiac catheterization, coronary-artery bypass grafting, percutaneous transluminal coronary angioplasty, carotid endarterectomy, reduction of femur fracture, total hip replacement, total knee replacement, partial colectomy, open cholecystectomy, closed cholecystectomy, hysterectomy, and prostatectomy. We adjusted the comparisons for sociodemographic case mix and for characteristics of the health plans other than their tax status, including the plans' location.Results:The rates of carotid endarterectomy, cardiac catheterization, coronary-artery bypass grafting, and percutaneous transluminal coronary angioplasty were higher in for-profit health plans than they were in not-for-profit health plans; the rates of use of other common costly operative procedures were similar in the two types of plan. After adjustment for enrollee case mix and other characteristics of the plans, the for-profit plans had significantly higher rates than the not-for-profit plans for 2 of the 12 procedures we studied and had lower rates for none. The geographic locations of the health plans did not explain these findings.Conclusions:Contrary to our expectations about the likely effects of financial incentives, the rates of use of high-cost operative procedures were not lower among beneficiaries enrolled in for-profit health plans than among those enrolled in not-for-profit health plans.