通过交换器识别医疗保险优势中的编码强度
Paul D Jacobs1, Timothy J Layton2
1U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Division of Research and Modeling, Rockville, Maryland, USA.
Health services research
|April 28, 2025
概括
与传统的医疗保险相比,医疗保险优势计划显示出更高的健康风险编码强度. 这种编码强度的差异随着时间的推移而增加,这表明Medicare Advantage注册人的潜在超支付.
科学领域:
- 卫生经济学 卫生经济学
- 医疗服务研究 医疗服务研究
- 医学编码分析分析
背景情况:
- 传统医疗保险 (TM) 和医疗保险优惠 (MA) 有不同的支付结构.
- 之前的研究表明,与TM相比,MA的诊断数量和严重程度更高.
- 了解编码强度差异对于准确的医疗保险支付至关重要.
研究的目的:
- 量化TM和MA之间的健康风险编码强度差异.
- 分析转换到MA的受益人编码强度如何随着时间的推移而演变.
- 提供根据编码强度调整MA支付的证据.
主要方法:
- 对从TM转换到MA的受益人与留在TM的受益人的风险评分进行比较.
- 使用了10%的医疗保险和医疗补助服务中心数据样本 (2012-2021).
- 与医疗保险当前受益者调查相关的行政数据,以测量健康状况.
主要成果:
- 转换MA的风险分数在第二年高出12.4%,第三年高出17.2%,第六年高出22.3%.
- 总体而言,MA编码强度导致2021年与TM相比,MA编码强度的风险得分高出18.6%.
- 编码强度随着时间的推移和不同的入学队伍而增加.
结论:
- 该研究的编码强度估计在现有文献中处于较高的水平.
- 调查结果解决了关于MA招生中内源性切换的担忧.
- 结果可以为MA支付的政策调整提供信息,以考虑编码强度差异.
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