比较美国医疗保险的覆盖选择,作为一个有助于坚持或转向保险计划的机制
Lisa M Grabert1, Brian J Miller2, Kathryn L Wagner3
1Marquette University, Straz Hall, P.O. Box 1881, Milwaukee, WI, USA. Lisa.grabert@marquette.edu.
BMC health services research
|February 26, 2026
概括
通过比较医疗保险覆盖范围的选择,增加了转向医疗保险优势 (MA) 的可能性. 了解这些选择对于在医疗保健中导航的受益人来说至关重要.
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
- 公共卫生政策 公共卫生政策
背景情况:
- 美国医疗保险计划面临着重大未来支出挑战,到2025年将超过1.1万亿美元.
- 医疗保险优势 (MA) 注册人数正在增加,大多数受益者现在选择私人保险公司.
- 在收费服务 (FFS) 医疗保险和MA之间受益人选择背后的决策机制仍未得到充分探索.
研究的目的:
- 调查比较保险选择与受益人决定转换或继续使用FFS Medicare或MA之间的关系.
- 确定影响医疗保险覆盖选择的因素.
主要方法:
- 采用了面板研究设计,使用了2019-2020年医疗保险当前受益者调查的数据.
- 这项研究分析了美国6214名医疗保险受益人的样本.
- 分析的重点是覆盖范围切换行为及其预测因素.
主要成果:
- 2020年,不到3%的受益人转换了保险,其中92%从FFS转向MA.
- 比较覆盖选项与更换 (69.2%) 的可能性增加密切相关.
- 拥有FFS和比较覆盖范围显著预测了切换,可能是因为评估了自费成本和补充利益.
结论:
- 覆盖范围比较是影响受益人转换医疗保险计划的决定的一个关键预测因素.
- 未来关于医疗保险支付结构的政策建议应纳入覆盖范围比较的作用.
- 了解受益者比较行为对于有效的医疗保险计划设计和受益者支持至关重要.
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