Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members
Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members
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DOI：
10.1111/j.1532-5415.2008.01804.x
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发表时间：
2008-08-01
影响因子：
6.3
通讯作者：
LoGerfo, James P.
中科院分区：
文献类型：
--
作者：
Ackermann, Ronald T.;Williams, Barbara;LoGerfo, James P.
目的：确定医疗保险管理医疗参保人参加体育活动福利是否与较低的医疗保健利用率和成本相关。设计：回顾性队列研究。环境：医疗保险管理式医疗。参与者：1188名至少参加过一次增强健身（EF）体育活动福利的老年人健康维护组织参与者和一组从未使用过该计划的匹配参与者。测量方法：对医疗成本和利用率进行估计。使用普通最小二乘回归，调整人口统计学、合并症、预防性服务使用指标和基线利用率或成本。在涉及连续倾向评分调整和具有非恒定方差假设的广义线性模型的敏感性分析中，检验了研究结果的稳健性。结果：EF参与者在项目第一年的总医疗费用相似，但在第二年，调整后的总费用比非EF参与者低1,186美元（P = 0.005）。差异部分归因于较低的住院费用（- 3,384美元；P = 0.02），这不是由高成本异常值造成的。每周平均一次或更多次参加EF的参与者在第一年（- 1,929美元；P < .001）和第二年（- 1,784美元；P < .001）的调整后总医疗费用低于非使用者。结论：健康计划覆盖老年人预防性体育活动福利是一种有希望的策略，可以在短期内避免重大的医疗保健费用。
OBJECTIVES: To determine whether participation in a physical activity benefit by Medicare managed care enrollees is associated with lower healthcare utilization and costs.DESIGN: Retrospective cohort Study.SETTING: Medicare managed care.PARTICIPANTS: A cohort of 1,188 older adult health maintenance organization enrollees who participated at least once in the EnhanceFitness (EF) physical activity benefit and a matched group of enrollees who never used the program.MEASUREMENTS: Healthcare costs and utilization were estimated. Ordinary least squares regression was used, adjusting for demographics, comorbidity, indicators of preventive service use, and baseline utilization or cost. Robustness of findings was tested in sensitivity analyses involving continuous propensity score adjustment and generalized linear models with nonconstant variance assumptions.RESULTS: EF participants had similar total healthcare costs during Year 1 of the program, but during Year 2, adjusted total costs were $1,186 lower (P = .005) than for non-EF users. Differences were partially attributable to lower inpatient costs (-$3,384; P = .02), which did not result from high-cost Outliers. Enrollees who attended EF an average of one visit or more per week had lower adjusted total healthcare costs in Year 1 (-$ 1,929; P < .001) and Year 2 (-$1,784; P < .001) than nonusers.CONCLUSION: Health plan coverage of a preventive physical activity benefit for seniors is a promising strategy to avoid significant healthcare costs in the short term.