初级保健的不断变化的格局:对付款人-初级保健整合的分析
Loren Adler1, Samantha Crow1, Matthew Fiedler1
1Brookings Institution, Economic Studies, Washington, DC 20036, USA.
Health affairs scholar
|July 4, 2025
概括
保险公司对初级保健实践的所有权正在增长,现在占市场的4.2%. 这种扩张与医疗保险优势招生和医院市场不那么集中,影响医疗保健竞争有关.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健市场分析
- 提供初级保健服务.
背景情况:
- 保险公司对初级保健实践的所有权迅速扩大.
- 这一趋势的全部程度,地理分布和市场动态尚不清楚.
研究的目的:
- 量化保险公司拥有的初级保健实践的规模和地理分布.
- 确定与支付人对初级保健的控制相关的市场驱动因素.
主要方法:
- 分析公司文件,并购数据库和保险公司目录 (2016-2023年).
- 确定由主要付款人 (Optum,Humana,Elevance,Aetna-CVS Health,Cigna) 经营的医疗团体.
- 在传统医疗保险和医疗保险优势初级保健市场的纳税人份额计算,全国和各县.
主要成果:
- 付款人经营的实践从0.78% (2016年) 增长到4.2% (2023年) 的全国初级保健市场的体积.
- 在全国范围内,Optum的持有率为2.71%,在三个大县占有率超过35%.
- 付款人经营的初级保健普及率与医疗保险优势透率正相关,与医院/雇主保险市场集中度负相关.
结论:
- 保险公司对初级保健的控制正在扩大,特别是在医疗保险优势入学率高,医院市场不那么集中的地区.
- 需要进一步的研究来评估对医疗服务,医疗支出和市场竞争的影响.
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