对传统医疗保险的潜在溢出影响,当医生承担医疗保险优势风险时
Boris Vabson, Kenneth Cohen1, Omid Ameli
1Optum Health, 11000 Optum Circle, Eden Prairie, MN 33554.
医生暴露于医疗保险优势 (MA) 风险支付安排的医生显示,传统医疗保险 (TM) 患者的质量和效率更好. 这表明MA支付模式可能有利于更广泛的TM计划.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 质量改善 质量改善
背景情况:
- 医疗保险优势 (MA) 使用风险支付安排,但它们对传统医疗保险 (TM) 患者结果的影响尚不清楚.
- 了解这种关系对于评估MA对医疗保健质量和效率的更广泛影响至关重要.
研究的目的:
- 为了确定与MA风险支付接触较高的提供者是否与他们的TM患者的优异结果有关.
- 评估MA基于风险的支付模式对TM受益人的溢出效应.
主要方法:
- 对2016-2019年医疗保险索赔数据进行了回顾性,横截面回归分析.
- 医生治疗的TM受益人的质量和效率指标与MA风险支付高低暴露的医生进行了比较.
- 根据患者人口统计和风险评分进行调整.
主要成果:
- 分析包括超过2200万个TM受益年.
- 患有高MA风险的医生在TM患者26项测量中的22项中与更高的质量和效率有关.
- 在这些措施中观察到的改善率在3%至82%之间.
结论:
- 这项研究是第一个将提供者MA风险支付暴露与TM患者结果联系起来的研究.
- 更高的MA风险暴露与TM患者更好的质量和效率相关.
- 研究结果表明,MA风险支付模式可能会产生超出MA范围的好处,可能会增强TM计划.
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