Kranker (2016) メディケイド疾病管理プログラムが医療費に与えた影響

近年のアメリカの多くの州で導入されているメディケイド疾病管理プログラムが医療費にどのような影響を与えたのかを検証した論文.プログラム導入は医療費適正化を掲げていたため,実際に医療費は削減されたのかを検証する必要がある.結果は,一人あたり一月平均 $89を削減したがこの額はプログラム導入よりも低いそうだ.日本のメタボ健診についてもこうした分析が必要.

Kranker, K. (2016). Effects of Medicaid disease management programs on medical expenditures: Evidence from a natural experiment in Georgia. Journal of Health Economics, 46, 52–69. 

In recent decades, most states’ Medicaid programs have introduced disease management programs for chronically ill beneficiaries. Interventions assist beneficiaries and their health care providers to appropriately manage chronic health condition(s) according to established clinical guidelines. Cost containment has been a key justification for the creation of these programs despite mixed evidence they actually save money. This study evaluates the effects of a disease management program in Georgia by exploiting a natural experiment that delayed the introduction of high-intensity services for several thousand beneficiaries. Expenditures for medical claims decreased an average of $89 per person per month for the high- and moderate-risk groups, but those savings were not large enough to offset the total costs of the program. Impacts varied by the intensity of interventions, over time, and across disease groups. Heterogeneous treatment effect analysis indicates that decreases in medical expenditures were largest at the most expensive tail of the distribution.