Legislative and Regulatory Options for Improving Medicare Advantage.

IF 3.3 3区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Erin C Fuse Brown, Travis C Williams, Roslyn C Murray, David J Meyers, Andrew M Ryan
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引用次数: 0

Abstract

The Medicare Advantage program was created to expand beneficiary choice and to reduce spending through capitated payment to private insurers. However, many stakeholders now argue that Medicare Advantage is failing to deliver on its promise to reduce spending. Three problematic design features in Medicare Advantage payment policy have received particular scrutiny: (1) how baseline payments to insurers are determined, (2) how variation in patient risk affects insurer payment, and (3) how payments to insurers are adjusted for quality performance. The authors analyze the statute underlying these three design features and explore legislative and regulatory strategies for improving Medicare Advantage. They conclude that regulatory approaches for improving risk adjustment and for recouping overpayments from risk-score gaming have the highest potential impact and are the most feasible improvement measures to implement.

改善医疗保险优势的立法和监管选择。
Medicare Advantage计划旨在扩大受益人的选择,并通过向私人保险公司按人头付费来减少支出。然而,许多利益相关者现在认为,Medicare Advantage未能兑现其减少支出的承诺。Medicare Advantage支付政策中有三个有问题的设计特征受到了特别的审查:(1)如何确定向保险公司的基线付款,(2)患者风险的变化如何影响保险公司的付款,以及(3)如何根据质量绩效调整向保险公司付款。作者分析了这三个设计特征背后的法规,并探讨了改善医疗保险优势的立法和监管策略。他们得出的结论是,改进风险调整和从风险评分游戏中收回超额支付的监管方法具有最大的潜在影响,是最可行的改进措施。
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来源期刊
CiteScore
7.30
自引率
7.10%
发文量
46
审稿时长
>12 weeks
期刊介绍: A leading journal in its field, and the primary source of communication across the many disciplines it serves, the Journal of Health Politics, Policy and Law focuses on the initiation, formulation, and implementation of health policy and analyzes the relations between government and health—past, present, and future.
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