在医疗保险优势中编码强度的变化
Vilsa E Curto1, Eran Politzer2, Timothy S Anderson3
1Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
医疗保险优势计划激励强烈的诊断编码,导致显著的编码通货膨胀. 一种使用死亡率的新方法发现,平均通货膨胀率为8.4%,影响了大多数入学者.
科学领域:
- 卫生经济学 卫生经济学
- 卫生政策 卫生政策
- 生物统计学 生物统计学
背景情况:
- 医疗保险优势 (MA) 注册人数超过50%的符合条件的受益人.
- 许可证支付依赖于基于前一年诊断的风险评分,为密集编码创造激励.
- 评估编码强度的现有方法存在局限性.
研究的目的:
- 用一种新的方法估计单个MA合同的编码通胀率.
- 分析与MA计划中更高编码强度相关的因素.
- 评估超过医疗保险调整的编码通货膨胀的流行情况.
主要方法:
- 开发了一种使用计划级死亡率推断编码强度的新方法.
- 将该方法应用于2014年医疗保险优势风险评分和健康状况数据.
- 分析了不同MA合约特征的编码通货膨胀率.
主要成果:
- 2014年注册人数加权平均编码通胀率为8.4%.
- 编码通货膨胀率在MA保险公司和合同之间有很大差异.
- 更高的编码强度与HMO,提供商拥有的计划,更大/更老的计划以及高星级的计划有关.
- 68.1%的注册医疗保险人有合同,其代码的通胀率超过了医疗保险的调整.
结论:
- 在医疗保险优势计划中存在显著的编码通胀.
- 这种新方法提供了一种可靠的方式来评估编码强度.
- 编码通货膨胀影响了大多数医疗保险优势计划的注册人,可能会影响计划的完整性.
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