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Geographic variation within the military health system

BACKGROUND: This study seeks to quantify variation in healthcare utilization and per capita costs using system-defined geographic regions based on enrollee residence within the Military Health System (MHS). METHODS: Data for fiscal years 2007 – 2010 were obtained from the Military Health System unde...

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Autores principales: Kimsey, Linda, Olaiya, Samuel, Smith, Chad, Hoburg, Andrew, Lipsitz, Stuart R., Koehlmoos, Tracey, Nguyen, Louis L., Weissman, Joel S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390405/
https://www.ncbi.nlm.nih.gov/pubmed/28407769
http://dx.doi.org/10.1186/s12913-017-2216-1
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author Kimsey, Linda
Olaiya, Samuel
Smith, Chad
Hoburg, Andrew
Lipsitz, Stuart R.
Koehlmoos, Tracey
Nguyen, Louis L.
Weissman, Joel S.
author_facet Kimsey, Linda
Olaiya, Samuel
Smith, Chad
Hoburg, Andrew
Lipsitz, Stuart R.
Koehlmoos, Tracey
Nguyen, Louis L.
Weissman, Joel S.
author_sort Kimsey, Linda
collection PubMed
description BACKGROUND: This study seeks to quantify variation in healthcare utilization and per capita costs using system-defined geographic regions based on enrollee residence within the Military Health System (MHS). METHODS: Data for fiscal years 2007 – 2010 were obtained from the Military Health System under a data sharing agreement with the Defense Health Agency (DHA). DHA manages all aspects of the Department of Defense Military Health System, including TRICARE. Adjusted rates were calculated for per capita costs and for two procedures with high interest to the MHS- back surgery and Cesarean sections for TRICARE Prime and Plus enrollees. Coefficients of variation (CoV) and interquartile ranges (IQR) were calculated and analyzed using residence catchment area as the geographic unit. Catchment areas anchored by a Military Treatment Facility (MTF) were compared to catchment areas not anchored by a MTF. RESULTS: Variation, as measured by CoV, was 0.37 for back surgery and 0.13 for C-sections in FY 2010- comparable to rates documented in other healthcare systems. The 2010 CoV (and average cost) for per capita costs was 0.26 ($3,479.51). Procedure rates were generally lower and CoVs higher in regions anchored by a MTF compared with regions not anchored by a MTF, based on both system-wide comparisons and comparisons of neighboring areas. CONCLUSIONS: In spite of its centrally managed system and relatively healthy beneficiaries with very robust health benefits, the MHS is not immune to unexplained variation in utilization and cost of healthcare.
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spelling pubmed-53904052017-04-14 Geographic variation within the military health system Kimsey, Linda Olaiya, Samuel Smith, Chad Hoburg, Andrew Lipsitz, Stuart R. Koehlmoos, Tracey Nguyen, Louis L. Weissman, Joel S. BMC Health Serv Res Research Article BACKGROUND: This study seeks to quantify variation in healthcare utilization and per capita costs using system-defined geographic regions based on enrollee residence within the Military Health System (MHS). METHODS: Data for fiscal years 2007 – 2010 were obtained from the Military Health System under a data sharing agreement with the Defense Health Agency (DHA). DHA manages all aspects of the Department of Defense Military Health System, including TRICARE. Adjusted rates were calculated for per capita costs and for two procedures with high interest to the MHS- back surgery and Cesarean sections for TRICARE Prime and Plus enrollees. Coefficients of variation (CoV) and interquartile ranges (IQR) were calculated and analyzed using residence catchment area as the geographic unit. Catchment areas anchored by a Military Treatment Facility (MTF) were compared to catchment areas not anchored by a MTF. RESULTS: Variation, as measured by CoV, was 0.37 for back surgery and 0.13 for C-sections in FY 2010- comparable to rates documented in other healthcare systems. The 2010 CoV (and average cost) for per capita costs was 0.26 ($3,479.51). Procedure rates were generally lower and CoVs higher in regions anchored by a MTF compared with regions not anchored by a MTF, based on both system-wide comparisons and comparisons of neighboring areas. CONCLUSIONS: In spite of its centrally managed system and relatively healthy beneficiaries with very robust health benefits, the MHS is not immune to unexplained variation in utilization and cost of healthcare. BioMed Central 2017-04-13 /pmc/articles/PMC5390405/ /pubmed/28407769 http://dx.doi.org/10.1186/s12913-017-2216-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kimsey, Linda
Olaiya, Samuel
Smith, Chad
Hoburg, Andrew
Lipsitz, Stuart R.
Koehlmoos, Tracey
Nguyen, Louis L.
Weissman, Joel S.
Geographic variation within the military health system
title Geographic variation within the military health system
title_full Geographic variation within the military health system
title_fullStr Geographic variation within the military health system
title_full_unstemmed Geographic variation within the military health system
title_short Geographic variation within the military health system
title_sort geographic variation within the military health system
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390405/
https://www.ncbi.nlm.nih.gov/pubmed/28407769
http://dx.doi.org/10.1186/s12913-017-2216-1
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