Health Care Spending Slowed After Rhode Island Applied Affordability Standards To Commercial Insurers
Health Care Spending Slowed After Rhode Island Applied Affordability Standards To Commercial Insurers
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DOI：
10.1377/hlthaff.2018.05164
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发表时间：
2019-02-01
期刊：
影响因子：
9.7
通讯作者：
Basu, Sanjay
中科院分区：
文献类型：
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作者：
Baum, Aaron;Song, Zirui;Basu, Sanjay
各州正在出台法规来减缓医疗保健支出的增长，但其中哪些成功地降低了支出增长仍不清楚。我们研究了罗得岛2010年的负担能力标准，该标准对商业保险公司与医院和诊所之间的合同实施了价格控制，特别是通货膨胀上限和基于诊断的支付，并要求商业保险公司增加其在初级保健和护理协调服务方面的支出。使用差异-无差异设计，我们比较了2007年至2016年期间罗得岛38,001名商业保险成年人与其他州38,001名匹配成年人的支出。相对于对照组的季度服务费（FFS）支出，罗得岛组的季度FFS支出在政策实施后每名注册者减少了76美元，比2009年的支出下降了8.1%。每季度非FFS初级保健协调支出增加了21美元。总支出增长下降，这是由于采取了价格控制措施，导致价格下降。质量措施未受影响或有所改善。罗得岛州的经验表明，各州可能能够通过价格控制来减缓商业医疗保健总支出的增长，同时保持质量。
States are introducing regulations to slow health care spending growth, but which of these successfully reduce spending growth remains unclear. We studied Rhode Island's 2010 affordability standards, which imposed price controls-particularly inflation caps and diagnosis-based payments-on contracts between commercial insurers and hospitals and clinics and required commercial insurers to increase their spending on primary care and care coordination services. Using a difference-indifferences design, we compared spending among 38,001 commercially insured adults in Rhode Island to that among 38,001 matched adults in other states in the period 2007-16. Relative to quarterly fee-for-service (FFS) spending among the control group, quarterly FFS spending among the Rhode Island group decreased by $76 per enrollee after implementation of the policy, or a decline of 8.1 percent from 2009 spending. Quarterly non-FFS primary care coordination spending increased by $21 per enrollee. Total spending growth decreased, driven by lower prices concordant with the adoption of price controls. Quality measures were unaffected or improved. The Rhode Island experience indicates that states may be able to slow total commercial health care spending growth through price controls while maintaining quality.