减少或限制商业计划支付给医院和医生的潜在联邦政策

Michael Cohen, Daria Pelech, Karen Stockley
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引用次数: 0

摘要

国会预算办公室(CBO)是一个无党派的联邦机构,其使命是支持美国国会预算程序,经常分析影响医疗保健提供者支付率或提供医疗保健成本的政策。这些政策可以通过改变医疗保险所涵盖服务的管理价格或通过影响商业保险公司支付给供应商的协商价格,直接影响供应商的收入。国会预算办公室不提出政策建议。相反,该机构的作用是对政策方法进行独立分析,并检查其对联邦预算和其他相关结果的影响。在这里,作者描述了一份根据国会要求编写的2022年9月报告。该机构审查了三组经常被提及的解决商业计划中协商支付价格增长的政策:促进供应商之间的竞争,提高价格透明度,限制价格水平或增长率。所考虑的每一种方法在前10年内对价格预期的影响将从非常小的下降(如果采用价格透明度政策(0.1%-1.0%))到小的下降(如果采用竞争政策(超过1.0%-3.0%)和适度的下降(超过3.0%-5.0%)到大的下降(超过5.0%),如果价格的水平和增长都受到限制。这些估计虽然不确定,但代表了国会预算办公室利用研究文献和最新数据的证据对政策效果的最佳评估。国会预算办公室预计,根据现行法律,到2032年,商业保险公司将向医院和医生支付1.5万亿美元的索赔。如果医院和医生的价格下降1%,那一年商业健康保险计划的保费总额将减少130亿美元。保费的减少反过来又会通过增加税收(因为从应税收入中扣除的保费金额会减少)和减少对自营职业者和根据《患者保护和可负担医疗法案》有资格获得补贴的人的医疗保险补贴来减少联邦预算赤字。因此,到2032年,联邦政府对商业医疗保险费的补贴将减少48亿美元,相当于现行法律规定的当年预算赤字的0.2%。作者没有预测政策对价格、保费和联邦预算以外的结果的影响——比如获得医疗服务的机会、医疗质量和提供者的成本——因为证据有限和相互矛盾,而且政策对价格的影响通常很小。国会预算办公室最近发布了一项呼吁,要求对那些显著影响医疗服务提供者收入的政策的影响进行更多的研究,以帮助该机构更好地分析未来相关政策的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Potential Federal Policies to Reduce or Limit Commercial Plan Payments to Hospitals and Physicians
SummaryThe Congressional Budget Office (CBO) is a nonpartisan federal agency that, aligned with its mission to support the U.S. Congressional budget process, frequently analyzes policies affecting health care providers’ payment rates or their costs of providing care. Such policies can directly affect providers’ revenues by changing the administered prices for services covered by Medicare or by affecting the negotiated prices paid to providers by commercial insurers. CBO does not make policy recommendations. Rather, the agency’s role is to produce independent analyses of policy approaches and examine their implications for the federal budget and other related outcomes. Here, the authors describe a September 2022 report that was prepared on the basis of a congressional request. The agency reviewed three families of policies that are frequently mentioned as solutions for the growth in the negotiated prices paid in commercial plans: promoting competition among providers, promoting price transparency, and capping the level or growth rate of prices. The effects on prices expected within the first 10 years for each of the approaches considered would range from very small reductions if the price transparency policies were adopted (0.1%–1.0%) to small reductions if the competition policies were adopted (more than 1.0%–3.0%) and moderate (more than 3.0%–5.0%) to large (more than 5.0%) reductions if both the level and growth of prices were capped. Those estimates, although uncertain, represent CBO’s best assessments of the effects of the policies using evidence from the research literature and the most recently available data. CBO projects that, under current law, commercial insurers would pay $1.5 trillion in claims from hospitals and physicians in 2032. If hospital and physician prices fell by 1%, premiums for commercial health insurance plans could be reduced by a total of $13 billion in that year. Reductions in premiums in turn would reduce the federal budget deficit by increasing tax revenues (because the amount of premiums excluded from taxable income would be lower) and by reducing subsidies for health insurance for the self-employed and people eligible for subsidies under the Patient Protection and Affordable Care Act. As a result, the federal government’s subsidies for commercial health insurance premiums would be reduced by $4.8 billion in 2032 or 0.2% of the budget deficit projected for that year under current law. The authors did not project the effects of the policies on outcomes other than prices, premiums, and the federal budget — such as access to care, quality of care, and providers’ costs — because of limited and conflicting evidence and because the policies’ effects on prices were generally small. CBO recently issued a call for more research on the effects of policies significantly affecting providers’ revenues on other outcomes that would help the agency better analyze the effect of related policies in the future.
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