在医疗保险中有利选择退伍军人优势:双重退伍军人健康管理局的风险调整成本差异
Allison Dorneo1, Steven D Pizer1,2, Melissa M Garrido1,2,3
1Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA.
Medical care
|October 9, 2025
概括
医疗保险优势 (MA) 计划招募比传统医疗保险 (TM) 更健康,更便宜的退伍军人. 这表明当前风险调整模型没有捕捉到潜在的选择偏差,突出了政策调整的需要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 老年学是一门学科.
背景情况:
- 医疗保险优势 (MA) 计划可能会因有利的入学者选择而过度支付,而不是由等级状况类别 (HCC) 风险调整所捕捉到的.
- 退伍军人卫生管理局 (VHA) 的Nosos风险评分为不同患者队列中有利选择提供了一个独特的衡量标准.
研究的目的:
- 检查区分退伍军人入学MA与传统医疗保险 (TM) 的特征.
- 量化之前未被检测到的双重VHA-Medicare注册人之间的有利选择.
主要方法:
- 利用了来自VHA调查和行政记录 (2016-2019) 的综合,横截面数据.
- 分析了VHA-Medicare双重登记者,评估特征,Nosos风险得分和VHA医疗保健成本.
主要成果:
- 与VHA-TM招生人相比,VHA-MA招生人年龄较大,更有可能获得医疗补助,不太可能使用VHA护理,并且在较低优先级组中.
- 在2019年,MA入学者比TM入学者表现出明显较低的Nosos风险得分 (表明更好的健康状况).
- 调整后的分析显示,与TM注册人相比,MA注册人的VHA成本较低.
结论:
- 医疗保险优势计划注册的退伍军人比传统医疗保险更健康,成本更低.
- 调查结果表明,MA计划可能会根据HCC风险调整遗漏的不可观察因素来选择入学者.
- 决策者应该考虑加强对双重VHA-MA入学者的风险调整因素.
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