Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays
Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays
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DOI：
10.1377/hlthaff.2015.1553
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发表时间：
2016-08-01
期刊：
影响因子：
9.7
通讯作者：
Kessler, Daniel P.
中科院分区：
文献类型：
--
作者：
Baker, Laurence C.;Bundorf, M. Kate;Kessler, Daniel P.
关于 Medicare Advantage 计划向提供者支付的价格与按服务收费 Medicare 支付的价格相比如何，一直存在争论。我们使用 Medicare 和医疗保健成本研究所的数据来确定 2009 年和 2012 年按服务收费 (FFS) Medicare、Medicare Advantage 计划和商业保险公司为医院服务支付的价格。我们计算了大都市区固定入院篮子的三种保险中每一种的每次入院平均价格及其随时间的变化趋势。在考虑了 Medicare Advantage 和 FFS Medicare 之间医院网络、地理区域和病例组合的差异后，我们发现 Medicare Advantage 计划为医院服务支付的费用比 FFS Medicare 低 5.6%。如果不考虑 Medicare Advantage 的狭窄网络，该计划的支付费用比 FFS Medicare 低 8.0%。我们还发现，商业计划支付的费率远高于 Medicare Advantage 或 FFS Medicare，并且还在不断增长。这种差异至少有一部分来自商业计划为有利可图的服务线路支付的高得多的价格。
There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per admission, and its trend over time, in each of the three types of insurance for fixed baskets of hospital admissions across metropolitan areas. After accounting for differences in hospital networks, geographic areas, and case-mix between Medicare Advantage and FFS Medicare, we found that Medicare Advantage plans paid 5.6 percent less for hospital services than FFS Medicare did. Without taking into account the narrower networks of Medicare Advantage, the program paid 8.0 percent less than FFS Medicare. We also found that the rates paid by commercial plans were much higher than those of either Medicare Advantage or FFS Medicare, and growing. At least some of this difference comes from the much higher prices that commercial plans pay for profitable service lines.