UNMET NEED AND USE OF VISION CARE BY MEDICARE BENEFIC.

医疗保险受益人未满足的视力保健需求和使用。

• 批准号: 2546255
• 负责人: CAROL M MANGIONE
• 金额: $ 33.86万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-09-30 至 1999-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2546255
• 关键词: Medicare /Medicaid; clinical research; health care cost /financing; health care policy; health care referral /consultation; health care service evaluation; health care service utilization; human subject; vision disorders

Description: The proposed research will examine how the use of specialist referrals and services may be affected by payment organization, focusing specifically on a comparison of the use of vision care specialists for Medicare patients in fee-for-service (FFS) versus capitated (CAP) managed care settings. Medicare patients were selected for analysis because of the likelihood of rapid movement of Medicare beneficiaries into managed care. Vision care was selected for analysis because of the prevalence of treatable vision problems among the elderly associated with significant health problems and because referrals for specialty care occur largely in an ambulatory setting and may be vulnerable to incentives to reduce specialist use. The three specific aims are: (1) to determine whether there are differences in the referral and treatment patterns and in costs attributed to vision care between Medicare beneficiaries in managed care to those under FFS; (2) to assess whether Medicare beneficiaries with visual complaints in managed care relative to those under FFS have greater vision-related disability or unmet needs; and (3) to determine whether the content and/or costs of vision care are affected by the type of risk-sharing arrangements in capitated Medicare managed care plans, specifically, plans in which only the primary care physician is capitated (CAP-FFS) and at full risk for the provision of specialty care versus plans in which the primary care physician and specialist are in the same financial risk pool (CAP-CAP) for plans covering vision services. A sample will be drawn from the Health Care Financing Administration (HCFA) beneficiary plan and from the master files of HCFA Group Health Plan. Only group health plans that provide for routine visual screening will be included, but distinctions in risk sharing arrangements as capitation or shared risk pool will be ensured. Data will be analyzed to test the following hypotheses: (1) that compared to FFS, managed care participants will have higher rates of screening, refraction, and replacement of eye glasses; fewer referrals and cataract surgical procedures, and poorer perceived access to care; and lower out-of-pocket and overall expenses; (2) patients in managed care will have greater severity of correctable vision problems (refractive error or cataracts), poorer visual functioning and health related quality of life, and longer waiting times for appointments and less satisfaction with access and more costs; and (3) that after adjusting for case mix, patients in CAP-CAP plans compared to CAP-FFS plans have fewer visits, lower procedure use, and lower costs. Specific models for testing hypotheses are not given.

描述：拟议的研究将探讨如何使用专家 推荐和服务可能会受到支付组织的影响，重点关注 特别是对视力保健专家的使用进行比较 按服务收费 (FFS) 与按人头 (CAP) 管理的医疗保险患者 护理设置。 选择医疗保险患者进行分析是因为 医疗保险受益人快速进入管理式医疗的可能性。 选择视力护理进行分析是因为可治疗的疾病普遍存在 老年人的视力问题与健康状况密切相关 问题，并且因为转诊专业护理主要发生在 门诊环境，可能容易受到减少专科医师的激励措施的影响 使用。 这三个具体目的是：（1）确定是否存在差异 转诊和治疗模式以及视力相关费用 管理式护理中的 Medicare 受益人与 FFS 下的受益人之间的护理； (2) 评估有视觉不适的 Medicare 受益人是否受到管理 相对于 FFS 下的护理人员而言，他们有更严重的视力相关残疾或 未满足的需求； (3) 确定愿景的内容和/或成本是否 照护受到按人头安排的风险分担安排类型的影响 医疗保险管理式医疗计划，特别是仅包含主要医疗保险的计划 护理医生按人头付费 (CAP-FFS)，并承担提供医疗服务的全部风险 专业护理与初级保健医生和 专家属于同一财务风险池 (CAP-CAP)，其计划涵盖 视觉服务。 样本将从医疗保健融资管理局 (HCFA) 抽取 受益人计划和 HCFA 团体健康计划的主档案。 仅有的 提供常规视觉筛查的团体健康计划将 包括在内，但风险分担安排的区别为按人头付费或 确保共享风险池。 将分析数据以检验以下假设：（1）比较 对于 FFS，管理式医疗参与者将获得更高的筛查率， 验光、更换眼镜；更少的转诊和白内障 外科手术以及获得护理的机会较差；和更低 自付费用和总体费用； (2) 接受管理式护理的患者将有 更严重的可矫正视力问题（屈光不正或 白内障）、视力功能较差和与健康相关的生活质量较差， 预约等待时间较长，访问满意度较低 以及更多的成本； (3) 在调整病例组合后，患者 与 CAP-FFS 计划相比，CAP-CAP 计划的就诊次数更少，程序也更少 使用，降低成本。 没有给出检验假设的具体模型。