完全风险的医疗保险和传统医疗保险之间的健康结果
Kenneth Cohen1, Boris Vabson, Jennifer Podulka
1Optum Health, 11000 Optum Circle, Eden Prairie, MN 33554.
The American journal of managed care
|August 20, 2025
概括
与传统医疗保险相比,有风险的医疗保险优势 (MA) 计划在20项措施中的16项表现出优越的质量和效率. 这表明受益者在负责任的护理安排中可能受益.
科学领域:
- 医疗服务研究
- 健康经济学
- 提高质量
背景情况:
- 传统医疗保险 (TM) 是一种收费模式.
- 医疗保险优势 (MA) 提供各种支付安排,包括双面风险模式 (风险MA).
- 了解绩效差异对于医疗保健政策和支付改革至关重要.
研究的目的:
- 将风险MA和TM受益者之间的质量和卫生资源利用情况进行比较.
- 提供有关负责任的护理安排的政策决策.
主要方法:
- 索赔和入学数据的回顾性横截面分析 (2016-2019).
- 检查了四个领域的20个绩效指标.
- 根据人口统计,地理和相关疾病调整后使用后勤回归.
主要成果:
- 这项研究涉及超过650万人年.
- 与TM相比,有风险的MA在20项测量中的16项表现更好.
- 改善包括更少的急性住院患者,重新入院和急诊室使用.
结论:
- 风险MA安排与TM相比具有更高的质量和效率.
- 调查结果支持向负责任的护理迈进,与CMS的目标保持一致.
- 对支付和服务提供模式的政策影响很大.
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