Medicare and Medicaid costs for schizophrenia patients by age cohort compared with costs for depression, dementia, and medically ill patients
Medicare and Medicaid costs for schizophrenia patients by age cohort compared with costs for depression, dementia, and medically ill patients
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DOI：
10.1176/appi.ajgp.11.6.648
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发表时间：
2003-11-01
影响因子：
7.2
通讯作者：
Pratt, SI
中科院分区：
文献类型：
--
作者：
Bartels, SJ;Clark, RE;Pratt, SI
目的：作者描述了精神分裂症患者各年龄组的人均医疗补助和医疗保险支出，并比较了精神分裂症患者与抑郁症、痴呆症和非精神病性疾病患者的支出。研究方法：1999年期间，在新罕布什尔州确定了19岁以上双重合格受益人的医疗补助和医疗保险索赔（精神分裂症：N = 1，423;抑郁症：N = 2，219;痴呆症：N = 1，942;单独的医学疾病：N = 4，260）。计算了住院、门诊、家庭保健、疗养院、药房、医生和其他服务的年人均加权平均支出。结果如下：精神分裂症患者的人均支出最高的是老年受益人（65-74岁为39，154美元，75岁以上为43，461美元），而年轻受益人（19-44岁为25，633美元，45-64岁为31，529美元）。门诊服务是年轻人（19-64岁）的最高支出，而疗养院服务是65岁以上的最高支出。精神分裂症患者的总支出超过了抑郁症、痴呆症或医学疾病患者的总支出，除了45-64岁的痴呆症支出最高。在65-74岁的人群中，精神分裂症的人均支出比抑郁症高11，304美元，比医学疾病高28，256美元。结论精神分裂症是成年人生活中最昂贵的疾病之一，并且随着年龄的增长，费用会增加。需要采取有效的干预措施，改善老年人的独立功能，同时采用创新的家庭和社区服务模式，减少对养老院的高使用率和支出。
Objective: The authors describe per-capita Medicaid and Medicare expenditures across age cohorts for individuals with schizophrenia and compare expenditures for patients with schizophrenia and those with depression, dementia, and non-psychiatric medical disorders. Methods: Medicaid and Medicare claims were identified for dually-eligible beneficiaries ages 19+ in New Hampshire during 1999 (schizophrenia: N = 1,423; depression: N = 2,219; dementia: N = 1,942; medical disorders alone: N = 4,260). Annual per-capita weighted average expenditures were calculated for inpatient, outpatient, home-health, nursing home, pharmacy, physician, and other services. Results: The greatest per-capita expenditures for individuals with schizophrenia were among older beneficiaries ($39,154 for ages 65-74 and $43,461 for ages 75+), versus younger beneficiaries ($25,633 for ages 19-44 and $31,529 for ages 45-64). Outpatient services were the highest expenditure among younger adults (ages 19-64), whereas nursing home services were the highest expenditure for ages 65+. Total expenditures for individuals with schizophrenia exceeded those for individuals with depression, dementia, or medical disorders across all age cohorts except age 45-64, where dementia expenditures were highest. Among individuals age 65-74, per-capita expenditures for schizophrenia were $11,304 higher than for depression and $28,256 higher than for medical disorders. Conclusion Schizophrenia is one of the most expensive disorders across the adult lifespan, and expenditures increase across age cohorts. Effective interventions are needed that improve independent functioning in older age, in conjunction with innovative models of home- and community-based services that decrease high use of and expenditures for nursing homes.