Shifting US Patterns of COVID-19 Mortality by Race and Ethnicity From June–December 2020

ObjectivesThe COVID-19 pandemic has disproportionately affected racial and ethnic minorities in the United States and has been devastating for residents of nursing homes (NHs). However, evidence on racial and ethnic disparities in COVID-19–related mortality rates within NHs and how that has changed over time has been limited. This study examines the impact of a high proportion of minority residents in NHs on COVID-19–related mortality rates over a 30-week period.DesignLongitudinal study.Setting and ParticipantsCenters for Medicare & Medicaid Services Nursing Home COVID-19 Public Use File data from 50 states from June 1, 2020, to December 27, 2020.MethodsWe linked data from 11,718 NHs to (1) Nursing Home Compare data, (2) the Long-Term Care: Facts on Care in the U.S., and (3) US county-level data on COVID cases and deaths. Our primary independent variable was proportion of minority residents (blacks and Hispanics) in NHs and its association with mortality rate over time.ResultsDuring the first 6 weeks from June 1, 2020, NHs with a higher proportion of black residents reported more COVID-19 deaths per 1000 followed by NHs with a higher proportion of Hispanic residents. Between 7 and 12 weeks, NHs with a higher proportion of Hispanic residents reported more deaths per 1000, followed by NHs with a higher proportion of black residents. However, after 23 weeks (mid-November 2020), NHs serving a higher proportion of white residents reported more deaths per 1000 than NHs serving a high proportion of black and Hispanic residents.Conclusions and ImplicationsThe disparities in COVID-19–related mortality for nursing homes serving minority residents is evident for the first 12 weeks of our study period. Policy interventions and the equitable distribution of vaccine are required to mitigate the impact of systemic racial injustice on health outcomes of people of color residing in NHs.     

农村医疗保险前后住院费用统计分析

目的对比分析2003年和2004年上半年本地农村户口住院病人在农村医疗保险实施前后疗效、疗程、费用的变化情况,以助于更有效的利用医保资金和医疗资源.方法以儿科几种常见单病种为例,应用SPSS统计软件进行统计分析.结果其治愈率、平均住院天数、平均医疗费用、平均药费及药费占总费用构成差异均有显著性.结论加强管理,控制医疗费用,提高医疗质量和病人满意度.     

The role of accountable care organizations in delivering value

The goal of Accountable Care Organizations is to improve patient outcomes while maximizing the value of the services provided. This will be achieved through the use of performance and quality measures that facilitate efficient, cost-effective, evidence-based care. By creating a network connecting primary care physicians, specialists, rehabilitation facilities and hospitals, patient care should be maximized while at the same time delivering appropriate value for those services provided. The Medicare Shared Savings Program will financially reward ACOs that meet performance standards while at the same time lowering costs. The orthopaedic surgeon can only benefit by understanding how to participate in and negotiate the complexities of these organizations.     

Total Joint Arthroplasty: Trends in Medicare Reimbursement and Implant Prices

Total joint arthroplasty (TJA) continues to be a popular target of cost control efforts. In order to provide a unique overview of financial trends facing TJA, we analyzed Medicare databases including 100% of beneficiaries, as well as industry surveys of implant list prices. Although there was a substantial increase in TJA utilization over the period 2000–2011 (+ 26.9%), growth has been stagnant since 2005. New coding schemes have made complicated cases more lucrative for hospitals (+ 2.5% to 6.5% per year), while reimbursements for uncomplicated cases have fallen (− 0.7% to − 0.6%). Physician reimbursements have declined on all case types (− 2.5% to − 2.1% per year), while list prices of orthopedic implants have risen (+ 4.8% to 5.5%). These trends should be kept in mind while contemplating future changes to TJA payment.     

部队与地方医保患者住院费用构成分析

目的分析综合性医院部队免费医疗与公务员医保患者住院药品费用占住院总费用的比例,为在保证治愈率前提下控制药品费用过度增长提供依据。方法选择医院2009年至2012年1795例住院患者,比较部队免费医疗与公务员医保患者的住院药品费用、检查费用占总住院费用的比例。结果在住院总费用中,药品费用所占比例较大。部队免费医疗与公务员医保两类患者住院总费用中,药品费用分别占7364元（41.73%）与4255元（44.12%）;部队患者的平均住院药品费用显著高于医保患者（P〈0.01）。结论部队患者存在着住院药品有防御性医疗的可能,控制住院药品费用须从患者主观因素、医院行为、医疗政策等着手。     

心血管介入疗法的成本效用分析

采用队列研究,根据支架手术预后和转归建立国产和进口支架的Markov模型,进行成本一效用分析。结果显示,进口支架的累计效用和成本均高于国产支架,进口支架多获得一个QALY需要多支付的成本小于一倍人均GDP,进口支架仍具成本效用。建议医疗保险部门在设置最高限价的同时预设付费标准;随着经济发展,适当提高最高限价,或者按价格分段设置不同的支付比例,以获得更多的效用产出。