救护车出租车:监管和诉讼对医疗保健欺诈行为的影响
Paul Eliason1, Riley League2, Jetson Leder-Luis3
1University of Utah and NBER.
概括
对于救护车服务的预先授权要求显著削减了医疗保险对不必要的透析旅行的支出,比起诉讼更有效. 这些新规定没有影响患者的健康结果.
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
- 检测医疗保健欺诈行为检测卫生保健欺诈行为
背景情况:
- 医疗保险在2003-2017年间为透析患者提供救护车服务的支出达到77亿美元.
- 这些救护车的很大一部分不符合医疗保险的退款标准.
- 现有的打击医疗欺诈的方法包括诉讼和预先规定.
研究的目的:
- 在制医疗保健欺诈方面,评估付款追逐诉讼与预先监管的比较有效性.
- 分析事先授权要求对医疗保险救护车服务支出的影响.
- 评估事先授权对患者健康结果的影响.
主要方法:
- 利用识别策略,利用美国各地分阶段实施的法规和诉讼.
- 从2003年到2017年,分析了与透析设施相关的救护车旅行的医疗保险支出数据.
- 将事先授权政策的影响与民事和刑事诉讼的影响进行比较.
主要成果:
- 预先授权要求大大降低了医疗保险对无偿救护车旅行的支出.
- 仅诉讼对减少医疗欺诈支出的影响不那么大.
- 由于实施事先授权,没有观察到对患者健康的不良影响.
结论:
- 预先的监管措施,特别是事先授权,在控制医疗保健欺诈方面比付款追逐诉讼更有效.
- 预先授权救护车服务提供了一种可行的策略,可以减少浪费的医疗保险支出,而不会影响患者的护理.
- 政策干预应考虑主动监管控制对医疗欺诈反应性执法的有效性.
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