Medicare and Medicaid: Conflicting incentives for long-term care
Medicare and Medicaid: Conflicting incentives for long-term care
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DOI：
10.1111/j.1468-0009.2007.00502.x
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发表时间：
2007-12-01
影响因子：
6.6
通讯作者：
Grabowski, David C.
中科院分区：
文献类型：
--
作者：
Grabowski, David C.
医疗保险和医疗补助的结构对双重资格的受益人产生了相互冲突的激励，而没有协调他们的护理。医疗保险和医疗补助都有兴趣限制他们的成本，而且都没有动力承担管理或护理质量的责任。不一致的激励措施的例子是医疗保险的成本分摊规则，家庭医疗保健和疗养院的成本转移，以及慢性和急性护理环境的成本转移。几项政策举措--按人头付费、按绩效付费以及将双重资格人群的医疗补助成本转移到联邦政府--可能会解决这些相互冲突的激励措施，但都有优缺点。随着婴儿潮一代的老龄化以及预计的联邦和州预算短缺，这一问题将成为未来几十年政策制定者的持续关注焦点。
The structure of Medicare and Medicaid creates conflicting incentives regarding dually eligible beneficiaries without coordinating their care. Both Medicare and Medicaid have an interest in limiting their costs, and neither has an incentive to take responsibility for the management or quality of care. Examples of misaligned incentives are Medicare's cost-sharing rules, cost shifting within home health care and nursing homes, and cost shifting across chronic and acute care settings. Several policy initiatives - capitation, pay-for-performance, and the shift of the dually eligible population's Medicaid costs to the federal government - may address these conflicting incentives, but all have strengths and weaknesses. With the aging baby boom generation and projected federal and state budget shortfalls, this issue will be a continuing focus of policymakers in the coming decades.