增加对医疗保险优势计划的支付,用于双重符合条件的受益人
Laura M Keohane1, Emma M Achola2,3, Daeho Kim4
1Department of Health Policy, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Ste 1200, Nashville, TN 37203.
The American journal of managed care
|February 27, 2026
概括
2017年的医疗保险政策变化增加了双重资格受益人的支付. 该研究发现,这并没有导致这些Medicare Advantage注册人的医疗保健使用或死亡率显著改善.
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
- 老年学是指老年学的学科.
背景情况:
- 医疗保险优势 (MA) 计划越来越多地注册双重资格受益人 (那些有资格获得医疗保险和医疗补助的人).
- 对于MA资本化支付的充分性存在担忧,特别是对于复杂的人群,如双重符合条件的个人.
- 2017年的一项联邦政策旨在通过调整风险分数来增加对某些双重资格受益人的支付.
研究的目的:
- 评估2017年医疗保险支付增加对医疗保健利用率和死亡率的影响.
- 确定MA计划中对双重资格受益人的增强支付是否转化为有形的健康结果.
主要方法:
- 采用差异差异分析,比较符合风险得分增加 (全医疗补助) 资格的受益人与没有资格的受益人 (部分医疗补助).
- 使用的CMS支付数据 (2014-2022) 和链接的医疗保险和最低数据集 (MDS) 数据 (2013-2019).
- 分析了熟练护理机构用户的住院使用,养老院使用,死亡率,再入院,长时间住院和365天死亡率.
主要成果:
- 计划级风险分数在超过一半会员拥有全额医疗补助计划的计划中增加了8.9%.
- 支付变化与65岁及以上受益人死亡率和医疗保健使用率的轻微,非临床显著下降有关.
- 对于年轻的双重资格受益者或任何年龄组的熟练护理设施用户,都没有观察到显著的影响.
结论:
- 该研究提出的问题是,增加的MA支付是否导致双重资格成员的质量有意义地改善.
- 随着MA入学人数在这一群体中不断增加,政策制定者必须监测更高的支付是否会导致更好的健康结果.
- 需要进一步的研究来了解MA支付水平与双重符合条件的个体的护理质量之间的关系.
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