国家监管供应商网络和目录的努力:未来的教训
Simon F Haeder1, Wendy Y Xu2, Thomas Elton2
1Texas A&M University.
Journal of health politics, policy and law
|July 27, 2023
概括
政府法规旨在确保提供者网络充足,管理护理计划中准确的目录. 然而,由于执法有限,他们的有效性受到质疑,需要进一步的研究和联邦改进.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策和法律卫生政策和法律
- "保险条例"中的保险条例.
背景情况:
- 管理护理是美国主要的医疗保险模式,依赖于合同提供者网络.
- 过去的"管理护理反响"导致了确保网络充足性和目录准确性的法规.
- 最近的实证工作质疑这些法规的有效性,特别是关于执法.
研究的目的:
- 对商业保险中提供者网络充足性和目录准确性进行全面审查.
- 评估针对服务不足的人群的法规.
- 评估最近联邦政府的努力及其与各州所学到的经验相结合.
主要方法:
- 审查有关供应商网络的州立立法和监管工作.
- 对共同和有针对性的充足性措施的分析.
- 评估联邦法规及其与州经验的关系.
主要成果:
- 各州已经实施了各种网络充足性和提供商目录准确性的规定.
- 具体条款针对的是服务不足的人群.
- 联邦法规在很大程度上反映了各州的方法,为共享学习提供了潜力.
结论:
- 国家努力规范网络充足性和目录准确性面临执法方面的挑战.
- 联邦法规可能受益于州级的洞察力.
- 需要进一步的研究来全面评估消费者获取倡议.
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