Medicare as Insurance Innovator: The Case of Hospice
Medicare as Insurance Innovator: The Case of Hospice
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DOI：
10.1177/1049909112461064
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发表时间：
2013-09-01
影响因子：
1.9
通讯作者：
Taylor, Donald H., Jr.
中科院分区：
文献类型：
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作者：
Taylor, Donald H., Jr.
典型的事实是，虽然私人保险倾向于在保险合同的福利设计方面进行创新，但医疗保险在支付方面引领了创新。传统或按服务收费的医疗保险在医疗保健服务的支付方面产生了许多创新，例如医院的预期支付、对护理进行分类的诊断相关组以及该计划用于支付医生的基于资源的相对价值系统，而私人保险则产生了一系列福利设计创新。这个故事忽略了医疗保险福利创新的一个重要例子：医疗保险临终关怀福利的创建。一个关键问题是医疗保险是否可以再次领导全系统的福利设计工作，以改进当前的临终关怀和姑息治疗政策。
The stylized fact is that while private insurance has tended to innovate on the benefit design side of the insurance contract, Medicare has lead innovation on the payment side. Traditional or Fee-For-Service Medicare has produced many innovations in the payment for health care services, such as Prospective Payment for hospitals, Diagnostic-Related Groups to categorize care, and the Resource-Based Relative Value System used by the program to pay physicians, while private insurance has produced a series of benefit design innovations. This story misses one important example of Medicare benefit innovation: the creation of the Medicare hospice benefit. A key question is whether Medicare can again lead a system-wide benefit design effort to improve upon current hospice and palliative care policy.