风险评级医疗保险的实践和道德
1Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Camden.
JAMA
|May 13, 1992
概括
美国医疗保险中的竞争性风险评级是昂贵和不公平的. 它无法保护那些医疗费用最高的人,并引发了伦理方面的担忧,与通用系统不同.
科学领域:
- 卫生经济学 卫生经济学
- 保险研究 保险研究
- 公共政策 公共政策
背景情况:
- 美国的医疗保险利用竞争性的风险评级,以保险人价值和对低风险个人的公平性进行推广.
- 这一系统与非竞争性,普遍的医疗保险模式形成对比.
研究的目的:
- 分析美国医疗保险中竞争性风险评级的实际和道德影响.
- 评估风险评级如何影响保险体系内成本和收益的分配.
主要方法:
- 分析美国医疗保险市场结构.
- 检查与风险评级相关的保险公司实践.
- 风险评级原则的伦理和经济批评.
主要成果:
- 竞争性风险评级比通用系统更昂贵,并且破坏了风险聚合的核心保险原则.
- 风险评级不成比例地有利于较低风险的个体,而不充分覆盖那些医疗费用最高的人.
- 保险公司从事复杂的操纵,以偏离精算上公平的定价,甚至公平的风险评级也会带来道德公平问题.
结论:
- 基于竞争性风险评级的当前医疗保险实践在经济上是低效的,在道德上是可疑的.
- 领先的国家医疗保险提案往往忽视了这些实际和道德上的挑战.
- 医疗行业和政策制定者需要就医疗保险的公平性和效率进行紧急讨论和政策立场.
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