国家保险市场的行政支出和利的实质性变化,2023年
Jason D Buxbaum1, Daniel R Arnold2, Erin C Fuse Brown3
1Jason D. Buxbaum (jason_buxbaum@brown.edu), Brown University, Providence, Rhode Island.
美国医疗保险的管理费用因州和计划类型而异. 降低这些成本,特别是医疗补助,每年可以节省数十亿美元.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
背景情况:
- 美国医疗保健系统每年在医疗保险管理上投入大量资金.
- 在不同的保险市场上存在管理成本和利的显著差异,但不完全理解.
- 了解这些成本驱动因素对于医疗改革和效率改进至关重要.
研究的目的:
- 估计2023年所有医疗保险计划的州级行政支出和利.
- 为了比较三个主要市场领域的行政成本和利:完全保险商业保险,医疗补助和自我资助的商业保险.
- 通过减少跨州中介机构的行政支出来确定潜在的节约.
主要方法:
- 利用州级监管文件收集有关行政支出和利的数据.
- 分析了三个不同的市场部分的数据:完全保险的商业保险,医疗补助和自我资助的商业保险.
- 在各州各个细分市场的每人,每年行政支出和利的计算中位数.
主要成果:
- 平均行政支出为599美元/人/年,用于全保险覆盖,为285美元/人/年,用于自筹资金覆盖.
- 医疗补助行政支出最高,在管理护理的州达到772美元/人/年.
- 在所有细分市场中观察到支出和利的显著州级变化.
结论:
- 在成本高于中位数至中位数的州减少行政支出和利,可以节省大量资金.
- 估计潜在的储蓄约为60亿美元 (完全保险),90亿美元 (医疗补助) 和40亿美元 (自我资助).
- 强调需要在医疗保险管理中提高透明度和效率,以控制医疗保健成本.
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