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1.
J Aging Soc Policy ; 32(1): 31-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-29979947

RESUMO

Individuals dually eligible for Medicare and Medicaid often receive fragmented and inefficient care. Using Minnesota fee-for-service claims, managed care encounters, and enrollment data for 2010-2012, we estimated the likely impact of Minnesota Senior Health Option (MSHO)-seen as the first statewide fully integrated Medicare-Medicaid model-on health care and long-term services and supports use, relative to Minnesota Senior Care Plus (MSC+), a Medicaid-only managed care plan with Medicare fee for service. Estimates suggest that MSHO enrollees had significantly higher use of primary care and, potentially, of community-based services, combined with lower use of hospital-based care than similar MSC+ enrollees. Adopting fully integrated care models like MSHO may have merit in other states.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Elegibilidade Dupla ao MEDICAID e MEDICARE , Serviços de Saúde para Idosos/normas , Planos Governamentais de Saúde/organização & administração , Idoso , Centers for Medicare and Medicaid Services, U.S. , Planos de Pagamento por Serviço Prestado/normas , Humanos , Programas de Assistência Gerenciada/normas , Minnesota , Estados Unidos
2.
Health Serv Res ; 54(6): 1233-1245, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31576563

RESUMO

OBJECTIVE: To examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. DATA SOURCE: 2010-2013 Medicare Current Beneficiary Survey. STUDY DESIGN: Retrospective analyses of survey-reported health and socioeconomic status (SES) measures among low-income Medicare beneficiaries and low-income dual enrollees. We used hierarchical linear regression models with state random effects to estimate the between-state variation in respondent characteristics and linear models to compare the characteristics of dual enrollees by state Medicaid policies. PRINCIPAL FINDINGS: Between-state differences in health and socioeconomic risk among low-income Medicare beneficiaries, as measured by the coefficient of variation, ranged from 17.5 percent for an index of socioeconomic risk to 20.3 percent for an index of health risk. Between-state differences were comparable among the subset of low-income beneficiaries dually enrolled in Medicare and Medicaid. Dual enrollees with incomes below the Federal Poverty Level were in better health and had higher SES in states that offered Medicaid to individuals with relatively higher incomes. Duals' average incomes were higher in states with Medically Needy programs. CONCLUSIONS: Characteristics of dual enrollees differ substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies. Risk-adjustment methods using dual enrollment to proxy for poor health and low SES should account for this state-level heterogeneity.


Assuntos
Elegibilidade Dupla ao MEDICAID e MEDICARE , Definição da Elegibilidade/normas , Medicaid/estatística & dados numéricos , Medicaid/normas , Medicare/estatística & dados numéricos , Medicare/normas , Risco Ajustado/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Governo Estadual , Estados Unidos
3.
Health Aff (Millwood) ; 38(7): 1101-1109, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31260369

RESUMO

Medicare's End-Stage Renal Disease Quality Incentive Program is a mandatory pay-for-performance program for US dialysis facilities, in which facilities are penalized up to 2 percent of their total Medicare payments based on their performance on quality metrics. While analyses of similar programs in other settings have shown performance to be related to social risk factors, it is unknown whether this program displays similar patterns. In this national study, facilities located in low-income ZIP codes and with high proportions of patients who were black or dually enrolled in Medicaid had lower performance scores and higher rates of penalization under the program. Independent (versus chain) status, large facility size, and urban location were also associated with penalties. Further study is needed to determine the degree to which these patterns reflect low-quality care delivery versus patient factors beyond providers' control. In the meantime, the impact of these penalties on providers serving vulnerable populations should be tracked closely.


Assuntos
Controle de Custos , Elegibilidade Dupla ao MEDICAID e MEDICARE , Falência Renal Crônica/terapia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Reembolso de Incentivo/economia , Humanos , Falência Renal Crônica/etnologia , Medicaid , Medicare , Pobreza , Fatores de Risco , Estados Unidos
4.
Health Aff (Millwood) ; 38(7): 1110-1118, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31260370

RESUMO

The benefits of expanding funding for Medicaid long-term care home and community-based services (HCBS) relative to institutional care are often taken as self-evident. However, little is known about the outcomes of these services, especially for racial and ethnic minority groups, whose members tend to use the services more than whites do, and for people with dementia who may need high-intensity care. Using national Medicaid claims data on older adults enrolled in both Medicare and Medicaid, we found that overall hospitalization rates were similar for HCBS and nursing facility users, although nursing facility users were generally sicker as reflected in their claims history. Among HCBS users, blacks were more likely to be hospitalized than non-Hispanic whites were, and the gap widened among blacks and whites with dementia. Also, conditional on receiving HCBS, Medicaid HCBS spending was higher for whites than for nonwhites, and higher Medicare and Medicaid hospital spending for blacks and Hispanics did not offset this difference. Our findings suggest that home and community-based services need to be carefully targeted to avoid adverse outcomes and that the racial/ethnic disparities in access to high-quality institutional long-term care are also present in HCBS. Policy makers should consider the full costs and benefits of shifting care from nursing facilities to home and community settings and the potential implications for equity.


Assuntos
Serviços de Saúde Comunitária/economia , Elegibilidade Dupla ao MEDICAID e MEDICARE , Disparidades em Assistência à Saúde/etnologia , Assistência de Longa Duração/economia , Idoso , Idoso de 80 Anos ou mais , Grupos Étnicos/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/economia , Humanos , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Estados Unidos
5.
JAMA Intern Med ; 179(6): 769-776, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985863

RESUMO

Importance: Beginning in fiscal year 2019, Medicare's Hospital Readmissions Reduction Program (HRRP) stratifies hospitals into 5 peer groups based on the proportion of each hospital's patient population that is dually enrolled in Medicare and Medicaid. The effect of this policy change is largely unknown. Objective: To identify hospital and state characteristics associated with changes in HRRP-related performance and penalties after stratification. Design, Setting, and Participants: A cross-sectional analysis was performed of all 3049 hospitals participating in the HRRP in fiscal years 2018 and 2019, using publicly available data on hospital penalties, merged with information on hospital characteristics and state Medicaid eligibility cutoffs. Exposures: The HRRP, under the 2018 traditional method and the 2019 stratification method. Main Outcomes and Measures: Performance on readmissions, as measured by the excess readmissions ratio, and penalties under the HRRP both in relative percentage change and in absolute dollars. Results: The study sample included 3049 hospitals. The mean proportion of dually enrolled beneficiaries ranged from 9.5% in the lowest quintile to 44.7% in the highest quintile. At the hospital level, changes in penalties ranged from an increase of $225 000 to a decrease of more than $436 000 after stratification. In total, hospitals in the lowest quintile of dual enrollment saw an increase of $12 330 157 in penalties, while those in the highest quintile of dual enrollment saw a decrease of $22 445 644. Teaching hospitals (odds ratio [OR], 2.13; 95% CI, 1.76-2.57; P < .001) and large hospitals (OR, 1.51; 95% CI, 1.22-1.86; P < .001) had higher odds of receiving a reduced penalty. Not-for-profit hospitals (OR, 0.64; 95% CI, 0.52-0.80; P < .001) were less likely to have a penalty reduction than for-profit hospitals, and hospitals in the Midwest (OR, 0.44; 95% CI, 0.34-0.57; P < .001) and South (OR, 0.42; 95% CI, 0.30-0.57; P < .001) were less likely to do so than hospitals in the Northeast. Hospitals with patients from the most disadvantaged neighborhoods (OR, 2.62; 95% CI, 2.03-3.38; P < .001) and those with the highest proportion of beneficiaries with disabilities (OR, 3.12; 95% CI, 2.50-3.90; P < .001) were markedly more likely to see a reduction in penalties, as were hospitals in states with the highest Medicaid eligibility cutoffs (OR, 1.79; 95% CI, 1.50-2.14; P < .001). Conclusions and Relevance: Stratification of the hospitals under the HRRP was associated with a significant shift in penalties for excess readmissions. Policymakers should monitor the association of this change with readmission rates as well as hospital financial performance as the policy is fully implemented.


Assuntos
Elegibilidade Dupla ao MEDICAID e MEDICARE , Economia Hospitalar/estatística & dados numéricos , Medicaid/economia , Medicare/economia , Readmissão do Paciente/economia , Estudos Transversais , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde/economia , Indicadores de Qualidade em Assistência à Saúde , Provedores de Redes de Segurança/economia , Estados Unidos
6.
Health Serv Res ; 54 Suppl 1: 243-254, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30666634

RESUMO

OBJECTIVE: To propose and evaluate a metric for quantifying hospital-specific disparities in health outcomes that can be used by patients and hospitals. DATA SOURCES/STUDY SETTING: Inpatient admissions for Medicare patients with acute myocardial infarction, heart failure, or pneumonia to all non-federal, short-term, acute care hospitals during 2012-2015. STUDY DESIGN: Building on the current Centers for Medicare and Medicaid Services methodology for calculating risk-standardized readmission rates, we developed models that include a hospital-specific random coefficient for either patient dual eligibility status or African American race. These coefficients quantify the difference in risk-standardized outcomes by dual eligibility and race at a given hospital after accounting for the hospital's patient case mix and proportion of dual eligible or African American patients. We demonstrate this approach and report variation and performance in hospital-specific disparities. PRINCIPAL FINDINGS: Dual eligibility and African American race were associated with higher readmission rates within hospitals for all three conditions. However, this disparity effect varied substantially across hospitals. CONCLUSION: Our models isolate a hospital-specific disparity effect and demonstrate variation in quality of care for different groups of patients across conditions and hospitals. Illuminating within-hospital disparities can incentivize hospitals to reduce inequities in health care quality.


Assuntos
Elegibilidade Dupla ao MEDICAID e MEDICARE , Disparidades em Assistência à Saúde , Hospitais/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Idoso , Grupos de Populações Continentais , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etnologia , Humanos , Revisão da Utilização de Seguros , Masculino , Medicare , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etnologia , Readmissão do Paciente/estatística & dados numéricos , Pneumonia/epidemiologia , Pneumonia/etnologia , Qualidade da Assistência à Saúde , Estados Unidos/epidemiologia
7.
Issue Brief (Commonw Fund) ; 2019: 1-9, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30681291

RESUMO

Issue: Older adults' needs have evolved and are no longer met by the Medicare program. With the recent passage of the Bipartisan Budget Act of 2018 (BBA), Medicare Advantage (MA) plans can now provide beneficiaries with nonmedical benefits, such as long-term services and supports (LTSS), which Medicare does not cover. Goal: To examine the use of LTSS among Medicare beneficiaries age 65 and older living in the community and explore differences by age, income, and other variables. Methods: Descriptive analyses of the National Health and Aging Trends Study (NHATS), 2015. Findings and Conclusions: Two-thirds of older adults living in the community use some degree of LTSS. Reliance on assistive devices and environmental modifications is high; however many adults, particularly dual-eligible beneficiaries, experience adverse consequences of not receiving care. Although the recent policy change allowing MA plans to offer LTSS benefits is an important step toward meeting the medical and nonmedical needs of Medicare beneficiaries, only the one-third of Medicare beneficiaries enrolled in MA plans stand to benefit. Accountable care organizations operating in traditional Medicare also should have the increased flexibility to provide nonmedical services.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Organizações de Assistência Responsáveis , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/estatística & dados numéricos , Elegibilidade Dupla ao MEDICAID e MEDICARE , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Medicaid , Medicare , Medicare Part C , Pobreza , Equipamentos de Autoajuda , Estados Unidos
8.
Med Care Res Rev ; 76(6): 711-735, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-29073847

RESUMO

Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1.8, 5.8]) increase in the probability of switching to partial Medicaid and a 4.5 percentage point (adjusted 95% confidence interval [2.9, 6.2]) increase in the probability of exiting Medicaid within 12 months. The predicted risk of leaving Medicaid was greatest when new Medicaid participants used only hospital services, rather than nursing home services, in their first month of Medicaid benefits. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.


Assuntos
Elegibilidade Dupla ao MEDICAID e MEDICARE , Definição da Elegibilidade , Pobreza , Governo Estadual , Idoso , Feminino , Humanos , Masculino , Estados Unidos
9.
Health Serv Res ; 53(6): 4416-4436, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30151882

RESUMO

OBJECTIVE: To identify hospital/county characteristics and sources of regional heterogeneity associated with readmission penalties. DATA SOURCES/STUDY SETTING: Acute care hospitals under the Hospital Readmissions Reduction Program from fiscal years 2013 to 2018 were linked to data from the Annual Hospital Association, Centers for Medicare and Medicaid Services, Medicare claims, Hospital Compare, Nursing Home Compare, Area Resource File, Health Inequity Project, and Long-term Care Focus. The final sample contained 3,156 hospitals in 1,504 counties. DATA COLLECTION/EXTRACTION METHODS: Data sources were combined using Medicare hospital identifiers or Federal Information Processing Standard codes. STUDY DESIGN: A two-level hierarchical model with correlated random effects, also known as the Mundlak correction, was employed with hospitals nested within counties. PRINCIPAL FINDINGS: Over a third of the variation in readmission penalties was attributed to the county level. Patient sociodemographics and the surrounding access to and quality of care were significantly associated with penalties. Hospital measures of Medicare volume, percentage dual-eligible and Black patients, and patient experience were correlated with unobserved area-level factors that also impact penalties. CONCLUSIONS: As the readmission risk adjustment does not include any community-level characteristics or geographic controls, the resulting endogeneity bias has the potential to disparately penalize certain hospitals.


Assuntos
Hospitais/estatística & dados numéricos , Medicare/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Risco Ajustado , Elegibilidade Dupla ao MEDICAID e MEDICARE , Humanos , Modelos Estatísticos , Estados Unidos
11.
Med Care ; 56(1): 47-53, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29227443

RESUMO

BACKGROUND: The implementation of Medicare part D on January 1, 2006 required all adults who were dually enrolled in Medicaid and Medicare (dual eligibles) to transition prescription drug coverage from Medicaid to Medicare part D. Changes in payment systems and utilization management along with the loss of Medicaid protections had the potential to disrupt medication access, with uncertain consequences for dual eligibles with human immunodeficiency virus (HIV) who rely on consistent prescription coverage to suppress their HIV viral load (VL). OBJECTIVE: To estimate the effect of Medicare part D on self-reported out-of-pocket prescription drug spending, AIDS Drug Assistance Program (ADAP) use, antiretroviral adherence, and HIV VL suppression among dual eligibles with HIV. METHODS: Using 2003-2008 data from the Women's Interagency HIV Study, we created a propensity score-matched cohort and used a difference-in-differences approach to compare dual eligibles' outcomes pre-Medicare and post-Medicare part D to those enrolled in Medicaid alone. RESULTS: Transition to Medicare part D was associated with a sharp increase in the proportion of dual eligibles with self-reported out-of-pocket prescription drug costs, followed by an increase in ADAP use. Despite the increase in out-of-pocket costs, both adherence and HIV VL suppression remained stable. CONCLUSIONS: Medicare part D was associated with increased out-of-pocket spending, although the increased spending did not seem to compromise antiretroviral therapy adherence or HIV VL suppression. It is possible that increased ADAP use mitigated the increase in out-of-pocket spending, suggesting successful coordination between Medicare part D and ADAP as well as the vital role of ADAP during insurance transitions.


Assuntos
Antivirais/economia , Elegibilidade Dupla ao MEDICAID e MEDICARE , Infecções por HIV/economia , Gastos em Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Medicare Part D/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Adulto , Idoso , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Carga Viral
12.
Policy Brief UCLA Cent Health Policy Res ; 2017(7): 1-8, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28990748

RESUMO

Los Angeles County has the state's lowest rate of consumer enrollment in Cal MediConnect, a program that is responsible for the delivery and coordination of medical, behavioral health, and long-term services and support benefits for individuals who are dually eligible for Medicare and Medi-Cal. This policy brief examines the factors that influence consumer decisions and may contribute to low enrollment rates. Influential factors include consumer knowledge of health care options, perception of choice, and disruption of existing care. Differences in decision making by age, complexity of health care needs, race/ethnicity, immigration status, and primary language are also noted. Policy recommendations include engaging consumers in the planning and dissemination of information about their health care options, optimizing consumer choice and implementing the least disruptive pathway to enrollment, and recognizing and responding to the great diversity of dual-eligible consumers in Los Angeles County.


Assuntos
Comportamento do Consumidor , Elegibilidade Dupla ao MEDICAID e MEDICARE , Serviços de Saúde/estatística & dados numéricos , California , Definição da Elegibilidade , Emigrantes e Imigrantes , Grupos Étnicos , Humanos , Los Angeles
15.
Med Care ; 54(9): 868-77, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27261640

RESUMO

BACKGROUND: The transition from Medicaid-only to dual Medicare/Medicaid coverage has the potential to reduce financial barriers to health care for patients with serious mental illness through increased coverage or expanded access to clinicians as their reimbursement increases. AIMS: To estimate the effect of dual coverage after Medicaid enrollment during the required waiting period among adults with serious mental illness on health care use, overall and related to mental health and substance use disorders (MHSUD). METHODS: Data include enrollment and claims from Medicaid and Medicare in Missouri and South Carolina, from January 2004 to December 2007. We used an interrupted time-series design to estimate the effect of dual coverage on average use of outpatient, emergency department (ED), and inpatient care/month. RESULTS: After 12 months of dual coverage, the probability of outpatient care use increased in both states from 4% to 9%. In Missouri, the mean probability and frequency of ED visits, total and MHSUD related, increased by 21%-32%; the probability of all-cause and MHSUD-related inpatient admissions increased by 10% and 19%, respectively. In South Carolina, the mean probability of any inpatient admission increased by 27% and of any MHSUD-related inpatient admission by 42%. DISCUSSION: The increase in use of outpatient care is consistent with the expected increase in coverage of, and payment for, outpatient services under dual coverage relative to Medicaid-only. Sustained increases in ED and inpatient admissions raise questions regarding the complexity of obtaining care under 2 programs, pent-up demand among beneficiaries pretransition, and the complementarity of outpatient and inpatient service use.


Assuntos
Elegibilidade Dupla ao MEDICAID e MEDICARE , Cobertura do Seguro/estatística & dados numéricos , Medicaid , Medicare , Transtornos Mentais/economia , Adulto , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Missouri , South Carolina , Estados Unidos , Adulto Jovem
16.
NCSL Legisbrief ; 24(4): 1-2, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27032126

RESUMO

Policymakers who are striving to achieve better health care, improved health outcomes and lower costs are considering new strategies and technologies. Telehealth is a tool that uses technology to provide health services remotely, and state leaders are looking to it now more than ever as a way to address workforce gaps and reach underserved patients. Among the challenges facing state lawmakers who are working to introduce or expand telehealth is how to handle covering patients and reimbursing providers.


Assuntos
Cobertura do Seguro/economia , Seguro Saúde/economia , Mecanismo de Reembolso/economia , Telemedicina/economia , Elegibilidade Dupla ao MEDICAID e MEDICARE , Planos de Assistência de Saúde para Empregados/economia , Humanos , Medicaid/economia , Medicare/economia , Patient Protection and Affordable Care Act , Governo Estadual , Telemedicina/legislação & jurisprudência , Estados Unidos , Populações Vulneráveis
17.
Cancer ; 121(20): 3591-9, 2015 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-26230631

RESUMO

BACKGROUND: Adults aged ≥65 years who are dually enrolled in Medicare and Medicaid are an at-risk group in health care. However, to the best of the authors' knowledge, the outcomes of women with gynecologic cancers in this population are unknown. METHODS: The current study was a population-based cohort study of North Carolina state cancer registry cases of uterine, ovarian, cervical, and vulvar/vaginal cancers (2003-2009), with linked enrollment in Medicare and state Medicaid. Outcomes of all-cause mortality and stage of disease at the time of diagnosis were analyzed as a function of enrollment status using multivariate analysis and survival curves. RESULTS: Of 4522 women aged ≥65 years (3702 of whom were enrolled in Medicare [82%] and 820 of whom were dually enrolled [18%]), there were 2286 cases of uterine (51%), 1587 cases of ovarian (35%), 302 cases of cervical (7%), and 347 cases of vulvar/vaginal (8%) cancers. Dual enrollees had increased all-cause mortality overall (adjusted hazard ratio [aHR], 1.34; 95% confidence interval [95% CI], 1.19-1.49), and within each cancer site (uterine: aHR, 1.22 [95% CI, 1.02-1.47]; ovarian: aHR, 1.25 [95% CI, 1.05-1.49]; cervical: aHR, 1.34 [95% CI, 0.96-1.87]; and vulvar/vaginal: aHR, 1.93 [95% CI, 1.36-2.72]). Increased odds of advanced-stage disease at the time of diagnosis among dual enrollees was only present in patients with uterine cancer (adjusted odds ratio, 1.38; 95% CI, 1.06-1.79). Stratified survival curves demonstrated the strongest disparities among women with early-stage uterine and early-stage vulvar/vaginal cancers. CONCLUSIONS: Women aged ≥65 years who were dually enrolled in Medicare and Medicaid were found to have an overall 34% increase in all-cause mortality after diagnosis with a gynecologic cancer compared with the non-dually enrolled Medicare population. Women with early-stage uterine and vulvar/vaginal cancers appeared to have the most disparate outcomes. Because these malignancies are generally curable, they have the most potential for benefit from targeted interventions.


Assuntos
Neoplasias dos Genitais Femininos/epidemiologia , Neoplasias dos Genitais Femininos/patologia , Idoso , Idoso de 80 Anos ou mais , Elegibilidade Dupla ao MEDICAID e MEDICARE , Feminino , Neoplasias dos Genitais Femininos/economia , Humanos , Assistência Médica/estatística & dados numéricos , Análise Multivariada , North Carolina/epidemiologia , Pobreza , Prognóstico , Medição de Risco , Análise de Sobrevida
20.
Health Serv Res ; 49(6): 1812-31, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25327166

RESUMO

OBJECTIVE: To examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries. DATA SOURCES: State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008. STUDY DESIGN: Cross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California. DATA EXTRACTION METHODS: We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months. PRINCIPAL FINDINGS: Personal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0-1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2-7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5-23.4). Payment rate was not associated with the probability of nursing facility entry. CONCLUSIONS: Higher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care.


Assuntos
Elegibilidade Dupla ao MEDICAID e MEDICARE , Gastos em Saúde , Assistência de Longa Duração/economia , Assistência de Longa Duração/estatística & dados numéricos , Assistência Individualizada de Saúde/economia , Assistência Individualizada de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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