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医疗保险的限制性 跨医生专业的优势提供者网络
Yevgeniy Feyman1, Jose Figueroa2, Melissa Garrido3
1Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC, USA.
Health services research
|April 9, 2024
概括
医疗保险优势提供者网络的限制性各不相同,农村受益者面临着更少的机会. 改善接入的努力应考虑专业的变化和市场因素.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
背景情况:
- 医疗保险优势 (MA) 计划提供了传统医疗保险 (TM) 的替代方案.
- 了解MA中提供者网络的限制性对于受益者访问至关重要.
- 市场因素可能会影响MA提供商网络的结构和可访问性.
研究的目的:
- 测量医疗保险优势计划中专业提供者网络的限制性.
- 检查网络限制性与各种市场因素之间的关联.
- 确定专业和地理区域,提供者访问可能有限.
主要方法:
- 使用的医疗保险处方药事件数据 (2011-2017年) 和区域健康资源档案.
- 使用基于预测模型的观察到预期比率计算提供商网络限制性.
- 使用多变量线性回归评估了网络限制性和市场因素之间的关系.
主要成果:
- 网络的限制性在各个专业之间有很大差异,其中产妇科是最具限制性的.
- 与较少限制性网络相关的因素包括更高的等级条件类别得分,更高的医生密度,更高的家庭收入中位数和更大的母公司市场份额.
- 农村地区是较为限制性网络的重要预测因素,表明这些地区的供应商访问减少.
结论:
- 农村受益者可能会经历不成比例地有限的访问MA网络内的专业提供商.
- 网络限制性受到专业类型,市场特征和地理位置的组合的影响.
- 增强供应商获取权的策略应根据特定的专业和当地市场条件,特别是农村环境.
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