加利福尼亚州市场成员的保险总成本
Emily Kohn1, Emory Wolf1, Isaac Menashe1
1Covered California, Sacramento, CA, United States.
Health affairs scholar
|August 6, 2025
概括
医疗保险的总成本,包括自付费用,在2019年至2022年为补贴可负担医疗法案 (ACA) 市场注册者减少. 这种提高的可负担性表明消费者减少了财务负担.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
- 医疗保险市场 医疗保险市场
背景情况:
- 关于"平价医疗法案" (ACA) 市场负担能力的讨论往往忽视了自付费用,主要关注的是保费.
- 覆盖的总成本包括保费,共同付款和自扣额,显著影响消费者的财务负担.
研究的目的:
- 在ACA市场中分析补贴医疗保险的总成本,以家庭收入的百分比计算.
- 为了比较2019年和2022年的保险负担能力,使用来自Covered California的索赔和入学数据.
主要方法:
- 利用了来自Covered California,加利福尼亚州ACA市场的索赔和入学数据.
- 计算了保险的总成本 (保费和自付费用) 作为补贴入学者的家庭收入的百分比.
- 在2019年至2022年期间,对家庭低于联邦贫困线400%的家庭进行了可负担度指标的比较.
主要成果:
- 在2022年,联邦贫困线以下400%的家庭的平均保险总成本为家庭收入的6.6%,低于2019年的8.7%.
- 负担能力的下降主要是由于净保费下降,而自费成本保持稳定.
- 总成本作为收入的百分比逐渐分配,并根据平板金属层而有所变化.
结论:
- 根据ACA的收入调整可负担性措施已经明显减轻了许多消费者的财务负担.
- 这些发现强调了在评估保险负担能力时考虑医疗保健总成本的重要性,而不仅仅是保费.
相关概念视频
01:26Methods Of Healthcare Delivery System
3.5K
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
3.5K
01:18Introduction To Health Care Delivery System
3.2K
The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
3.2K
01:30Health Information Technology and Healthcare Information System
922
Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
922
01:30Preventive Healthcare Services
1.1K
Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
1.1K
01:11Secondary Healthcare System
1.6K
Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
1.6K
01:29Issues And Trends In Healthcare Delivery System
5.8K
The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
5.8K