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NEJM：养老院入住者增多，医保支出增加

2015-05-11 MedSci MedSci原创

临终照护养老医保
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 在生命最后一年中，医疗保险的支持占据了医保系统年度支出的四分之一。在2000年和2012年之间，进入养老院的医保死者百分比翻倍，从23%上升到47%。养老院支出则相应的增加至原先的五倍（从29亿美元上升至151亿美元）。进入养老院的人数持续性地上升，这一上升结果是否降低了临终支出仍旧未知。为了研究这其中的联系，研究人员使用了双重差分跨时间匹配分析方法。 在2004年到2009

在生命最后一年中，医疗保险的支持占据了医保系统年度支出的四分之一。在2000年和2012年之间，进入养老院的医保死者百分比翻倍，从23%上升到47%。养老院支出则相应的增加至原先的五倍（从29亿美元上升至151亿美元）。进入养老院的人数持续性地上升，这一上升结果是否降低了临终支出仍旧未知。为了研究这其中的联系，研究人员使用了双重差分跨时间匹配分析方法。

在2004年到2009年间养老院的扩大增加创造了一个天然的实验，使得研究人员可以进行双重差分匹配分析以检验分析生命最后一年的医保支出与这一扩增的联系。此外，研究人员还评估了在临终30天的晚期痴呆者重症监护室（ICU）使用以及饲管使用和临终90天的医院转移情况。研究人员对比了自2009年起的入住养老院的人的一部分和相应的自2004年未入住养老院的人，他们被认为有可能入住养老院而在2009年去世。

786328名养老院死者中，2004年有27.6%，2009年有39.8%选择了养老院。2004年和2009年匹配的养老院和非养老院群体是相似的（平均年龄85岁，35%男性，25%患癌症）。养老院入住的增加与医院转院率、饲管使用和ICU使用的显著下降有关。五年之间，养老院平均停留时间从72.1天增加到92.6天。数据也反映出医保支出在养老院照护比医院和其他照护更多。

此项研究表明，养老院照护的增加与更少的临近死亡的强效照护有关，但医保支出总体上升。

原始出处：
Pedro Gozalo, Ph.D., Michael Plotzke, Ph.D., Vincent Mor, Ph.D.,
Susan C. Miller, Ph.D., and Joan M. Teno, M.D.Changes in Medicare Costs with the Growth of Hospice Care in Nursing Homes.N Engl J Med 2015;372:1823-31.

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    2015-05-13 huaxipanxing

    看看

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=23387, encodeId=536f2338e8d, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Wed May 13 21:02:00 CST 2015, time=2015-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1455501, encodeId=0558145550149, content=<a href='/topic/show?id=1e35302e085' target=_blank style='color:#2F92EE;'>#养老院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30270, encryptionId=1e35302e085, topicName=养老院)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f2715667301, createdName=tulenzi, createdTime=Wed May 13 13:58:00 CST 2015, time=2015-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23214, encodeId=9ba323214c9, content=老龄化社会已经来临, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=121e1622385, createdName=chenhui888, createdTime=Tue May 12 08:00:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23190, encodeId=62be2319078, content=普通人怎么办？, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=yydlt, createdTime=Tue May 12 07:02:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23180, encodeId=67c623180b2, content=没有比较过，不过确实老人越来与多, beContent=null, objectType=article, channel=null, level=null, likeNumber=160, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Mon May 11 23:41:00 CST 2015, time=2015-05-11, status=1, ipAttribution=)]
    2015-05-13 tulenzi

    #养老院#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=23387, encodeId=536f2338e8d, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Wed May 13 21:02:00 CST 2015, time=2015-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1455501, encodeId=0558145550149, content=<a href='/topic/show?id=1e35302e085' target=_blank style='color:#2F92EE;'>#养老院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30270, encryptionId=1e35302e085, topicName=养老院)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f2715667301, createdName=tulenzi, createdTime=Wed May 13 13:58:00 CST 2015, time=2015-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23214, encodeId=9ba323214c9, content=老龄化社会已经来临, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=121e1622385, createdName=chenhui888, createdTime=Tue May 12 08:00:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23190, encodeId=62be2319078, content=普通人怎么办？, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=yydlt, createdTime=Tue May 12 07:02:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23180, encodeId=67c623180b2, content=没有比较过，不过确实老人越来与多, beContent=null, objectType=article, channel=null, level=null, likeNumber=160, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Mon May 11 23:41:00 CST 2015, time=2015-05-11, status=1, ipAttribution=)]
    2015-05-12 chenhui888

    老龄化社会已经来临

    0

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    2015-05-12 yydlt

    普通人怎么办？

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=23387, encodeId=536f2338e8d, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Wed May 13 21:02:00 CST 2015, time=2015-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1455501, encodeId=0558145550149, content=<a href='/topic/show?id=1e35302e085' target=_blank style='color:#2F92EE;'>#养老院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30270, encryptionId=1e35302e085, topicName=养老院)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f2715667301, createdName=tulenzi, createdTime=Wed May 13 13:58:00 CST 2015, time=2015-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23214, encodeId=9ba323214c9, content=老龄化社会已经来临, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=121e1622385, createdName=chenhui888, createdTime=Tue May 12 08:00:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23190, encodeId=62be2319078, content=普通人怎么办？, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=yydlt, createdTime=Tue May 12 07:02:00 CST 2015, time=2015-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=23180, encodeId=67c623180b2, content=没有比较过，不过确实老人越来与多, beContent=null, objectType=article, channel=null, level=null, likeNumber=160, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=hbwang006, createdTime=Mon May 11 23:41:00 CST 2015, time=2015-05-11, status=1, ipAttribution=)]
    2015-05-11 hbwang006

    没有比较过，不过确实老人越来与多

    0