在商业保险成年人中,Medicare基于价值的方法和护理使用
Kun Li1,2, Sara Debab1, Frank McStay1
1Duke-Margolis Institute for Health Policy, Duke University, Washington, DC, and Durham, NC.
The American journal of managed care
|February 27, 2026
概括
医疗保险共享储蓄计划 (MSSP) 问责护理组织 (ACO) 和医疗保险优势 (MA) 的增长没有影响商业保险人口的医疗保健使用. 这表明在医疗保健支付改革中,不同支付人之间可能存在不一致的激励机制.
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:
- 负责任的护理组织 (ACO) 和医疗保险优势 (MA) 是美国医疗改革的关键组成部分.
- 了解它们对超出医疗保险受益者的影响对于评估更广泛的医疗保健系统变化至关重要.
研究的目的:
- 调查医疗保险共享储蓄计划 (MSSP) ACO和医疗保险优势 (MA) 透和商业保险人员医疗保健利用之间的关系.
- 确定医疗保险计划的增长是否会导致私人保险市场的溢出效应.
主要方法:
- 一项利用医疗保健成本研究所索赔数据的重复横截面研究从2015-2019年开始.
- 分析包括所有美国各州超过1300万年龄在55-64岁的商业保险入学者.
- 线性模型评估了县级MSSP ACO/MA透率和预防性护理,急诊室访问和住院治疗之间的关系.
主要成果:
- 在2015年至2019年期间,大多数美国县都观察到MSSP ACO和MA透率的显著增加.
- 尽管有这种增长,但MSSP ACO和MA透率与商业注册人员使用预防护理的变化没有实质性的关联.
- 在商业保险人口中,没有发现急诊室访问或住院住院的显著影响.
结论:
- 扩大MSSP ACO和MA并没有导致商业保险人群在医疗保健利用方面发生重大变化.
- 没有溢出效应可能表明医疗保险和商业纳税人之间的激励机制不一致.
- 建议将多重支付对齐作为正在进行的医疗保健支付改革成功的关键因素.
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