Duplicate Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System
| Autor: | Lan Jiang, Vincent Mor, Amal N. Trivedi, Jean Yoon, Regina C. Grebla, Kenneth W. Kizer |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Gerontology
Financing Government medicine.medical_specialty Population Eligibility Determination Context (language use) Medicare Advantage Article Patient Admission Ambulatory care Health care Ambulatory Care Humans Medicine Medicare Part C education Veterans Affairs health care economics and organizations Aged Retrospective Studies Veterans Aged 80 and over education.field_of_study business.industry Managed Care Programs Health Care Costs General Medicine Health Services United States United States Department of Veterans Affairs Surgical Procedures Operative Family medicine Managed care Female business |
| Zdroj: | JAMA. 308 |
| ISSN: | 0098-7484 |
| DOI: | 10.1001/jama.2012.7115 |
| Popis: | Context Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan. Objective To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees. Design Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004-2009. Main Outcome Measures Use of health services and inflation-adjusted estimated VA health care costs. Results Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees totaled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n = 21 353 841), 15% of all acute medical and surgical admissions (n = 177 663), and 18% of all acute medical and surgical inpatient days (n = 1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care). Conclusions The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals. |
| Databáze: | OpenAIRE |
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