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首页> 外文期刊>Inquiry: a journal of medical care organization, provision and financing >Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data:
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Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data:

机译：传统医疗保险与医疗保险优势之间的死亡率差异：使用索赔数据进行风险调整后的评估：

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Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set. The mortality model adjusted for clinical conditions and demographic factors. Model development considered the effect of potentially greater coding intensity in the MA population. Further analysis calculated ratios for subpopulations. Predicted, risk-adjusted mortality was lower in the MA population than in FFS Medicare. However, the ratio of actual-to-predicted mortality (0.80) suggested that the individuals in the MA data set were less likely to die than would be predicted had those individuals been enrolled in FFS Medicare. Differences between actual and predicted mortality were particularly pronounced in low income (dual eligibility), nonwhite race, high morbidity, and Health Maintenance Organization (HMO) subgroups. After controlling for baseline clinical risk as represented by claims diagnosis data, mortality differences favoring MA over FFS Medicare persisted, particularly in vulnerable subgroups and HMO plans. These findings suggest that differences in morbidity do not fully explain differences in mortality between the 2 programs.
机译：自《平价医疗法案》以来，Medicare Advantage（MA）的发展迅速。现在，近三分之一的Medicare受益人选择MA。如死亡率差异所反映的，这两种选择方案的比较价值评估受到明显的偏向于MA的选择偏差的混淆。先前的评估因无法访问MA人群的索赔诊断数据而受到阻碍。通过在传统的按服务付费（FFS）Medicare数据集上对死亡率进行建模，然后将该模型应用于MA数据集，然后评估实际死亡率与预测死亡率的比率，可以间接比较死亡率作为结果变量在MA数据集中。根据临床状况和人口统计学因素调整了死亡率模型。模型开发考虑了MA群体中可能更高的编码强度的影响。进一步分析计算了亚群的比率。在MA人群中，经风险调整后的预测死亡率低于FFS Medicare。但是，实际死亡率与预期死亡率之比（0.80）表明，MA数据集中的患者死亡的可能性比加入FFS Medicare的患者低。在低收入（双重资格），非白人，高发病率和健康维持组织（HMO）子组中，实际死亡率和预期死亡率之间的差异尤为明显。在以索赔诊断数据表示的基准临床风险得到控制后，与MAS FFS医疗保险相比，MA的死亡率差异仍然存在，特别是在易受伤害的亚组和HMO计划中。这些发现表明，发病率的差异不能完全解释这两种方案之间的死亡率差异。

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