改善医疗保险优势的立法和监管选择
Erin C Fuse Brown1, Travis C Williams1, Roslyn C Murray2
1Georgia State University.
Journal of health politics, policy and law
|July 27, 2023
概括
医疗保险优惠支付政策可能无法减少支出. 对风险调整和回收超额支付的监管改进显示出增强该计划的最大希望.
科学领域:
- 卫生经济学 卫生经济学
- 卫生政策 卫生政策
- 公共卫生 公共卫生
背景情况:
- 医疗保险优势计划旨在增加选择,并通过向私人保险公司支付资本化支付来减少医疗保健支出.
- 人们担心Medicare Advantage没有达到其节省成本的目标.
- 具体的支付政策特征,包括基准支付的确定,风险调整和质量绩效调整,正在审查中.
研究的目的:
- 分析有问题的医疗保险优势支付设计特征的法定基础.
- 探索立法和监管战略,以提高医疗保险优势计划的效率和成本效益.
- 确定最具影响力和可行的改进措施.
主要方法:
- 对管理医疗保险优势支付政策的立法和监管框架的分析.
- 检查三个关键设计特征:基线支付的确定,风险调整和质量绩效调整.
- 评估潜在的立法和监管干预措施.
主要成果:
- 目前的医疗保险优势支付政策的设计对降低成本提出了挑战.
- 风险调整和从风险评分游戏中收回过度支付被确定为改善的关键领域.
- 监管策略似乎比广泛的立法变化更可行和更有影响力.
结论:
- 对医疗保险优势风险调整的监管改进对于计划完整性至关重要.
- 实施措施以防止和收回风险评分游戏的过度付款至关重要.
- 有针对性的监管行动是改善Medicare Advantage节省成本潜力的最实用的途径.
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