Medicare Part D: Time for Re-Modernization?
Medicare Part D: Time for Re-Modernization?
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DOI：
10.1111/1475-6773.13221
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发表时间：
2019-12-01
影响因子：
3.4
通讯作者：
Trish, Erin E.
中科院分区：
文献类型：
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作者：
Trish, Erin E.
目的了解在再保险补贴增加的情况下保持D部分受益人保费稳定的机制。从2007年到2015年，关于D部分计划投标、联邦补贴和索赔的二手数据。研究设计：比较标准化的入学加权平均D部分计划投标和再保险投标，以及根据D部分索赔数据计算的计划和再保险责任。数据收集/提取方法D部分计划支付数据与保费数据合并，得出计划投标，并与基于索赔的支出措施合并。主要调查结果计划投标和再保险投标越来越偏离研究期间索赔数据中观察到的支出。这一差异可归因于回扣的增长和预期再保险赔付的系统性低价竞标，这使得计划能够将保费保持在较低水平，并在2015年获得约占D部分总支出3%的超额联邦补贴。尽管联邦再保险补贴不断增加，但通过再保险对账获得的回扣和超额联邦补贴的收入在保持D部分保费较低方面发挥了重要作用。尽管政策制定者应考虑实施改革，以解决该计划中的这些错误激励，但这样做很可能导致保费不可避免地增加到更能反映实际净支出的水平。
Objective To understand the mechanisms that have held Part D beneficiary premiums stable despite increasing reinsurance subsidies. Data Sources Secondary data on Part D plan bids, federal subsidies, and claims from 2007 through 2015. Study Design Comparisons of standardized, enrollment-weighted average Part D plan bids and reinsurance bids with plan and reinsurance liability calculated from Part D claims data. Data Collection/Extraction Methods Part D plan payment data were merged with premium data to derive plan bids, which were merged with claims-based spending measures. Principal Findings Plan bids and reinsurance bids increasingly diverged from the spending observed in the claims data over the study period. This divergence was attributable to the growth in rebates and systematic under-bidding of expected reinsurance payments, enabling plans to hold premiums low and collect excess federal subsidies of approximately 3 percent of total Part D spending in 2015. Conclusions Revenue from rebates and excess federal subsidies via reinsurance reconciliation has played an important role in holding Part D premiums low, despite increasing federal reinsurance subsidies. While policy makers should consider implementing reforms to address these misincentives in the program, doing so is likely to result in unavoidable premium increases to levels more reflective of actual net spending.