An Economic History of Medicare Part C
An Economic History of Medicare Part C
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DOI：
10.1111/j.1468-0009.2011.00629.x
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发表时间：
2011-06-01
影响因子：
6.6
通讯作者：
Sinaiko, Anna D.
中科院分区：
文献类型：
--
作者：
McGuire, Thomas G.;Newhouse, Joseph P.;Sinaiko, Anna D.
内容：25年前，私人保险计划被引入到医疗保险计划中，其双重目标是（1）让受益人在医疗保险计划之外选择健康保险计划，（2）将私营部门管理式医疗所实现的效率和成本节约转移到医疗保险计划中。方法：在这篇文章中，我们回顾了医疗保险C部分的经济历史，今天被称为医疗保险优势，专注于该计划的结构和计划支付方式的重大变化对私人计划，计划注册和医疗保险支出的可用性趋势的影响。此外，我们比较的经验，医疗保险优势和雇主赞助的健康保险与管理的医疗在同一时间periods.Findings：受益人获得私人计划一直不一致，在该计划的历史，更高的计划付款导致更多的选择和招生，反之亦然。但是，医疗保险优势一般比传统的医疗保险计划，超额支付，近年来增加了。结论：医疗保险优势的支付规则的重大变化是必要的，以同时鼓励私人计划的参与，提供高质量的护理，并节省医疗保险的钱。
Context: Twenty-five years ago, private insurance plans were introduced into the Medicare program with the stated dual aims of (1) giving beneficiaries a choice of health insurance plans beyond the fee-for-service Medicare program and (2) transferring to the Medicare program the efficiencies and cost savings achieved by managed care in the private sector.Methods: In this article we review the economic history of Medicare Part C, known today as Medicare Advantage, focusing on the impact of major changes in the program's structure and of plan payment methods on trends in the availability of private plans, plan enrollment, and Medicare spending. Additionally, we compare the experience of Medicare Advantage and of employer-sponsored health insurance with managed care over the same time period.Findings: Beneficiaries' access to private plans has been inconsistent over the program's history, with higher plan payments resulting in greater choice and enrollment and vice versa. But Medicare Advantage generally has cost more than the traditional Medicare program, an overpayment that has increased in recent years.Conclusions: Major changes in Medicare Advantage's payment rules are needed in order to simultaneously encourage the participation of private plans, the provision of high-quality care, and to save Medicare money.