《患者保护和平价医疗法案》关于医疗损失比率和质量的规定:来自德克萨斯州的证据。

Q4 Medicine

Journal of Health Care Finance Pub Date : 2013-01-01

Troy Quast

{"title":"《患者保护和平价医疗法案》关于医疗损失比率和质量的规定:来自德克萨斯州的证据。","authors":"Troy Quast","doi":"","DOIUrl":null,"url":null,"abstract":"Objectives: The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies.Methods: I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects.Results: Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative.Conclusions: Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality.","PeriodicalId":56181,"journal":{"name":"Journal of Health Care Finance","volume":"40 1","pages":"1-10"},"PeriodicalIF":0.0000,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Patient Protection and Affordable Care Act's provisions regarding medical loss ratios and quality: evidence from Texas.\",\"authors\":\"Troy Quast\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objectives: The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies.Methods: I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects.Results: Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative.Conclusions: Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality.\",\"PeriodicalId\":56181,\"journal\":{\"name\":\"Journal of Health Care Finance\",\"volume\":\"40 1\",\"pages\":\"1-10\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2013-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Health Care Finance\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health Care Finance","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

目标:《患者保护和平价医疗法案》(PPACA)包括一项规定，如果保险公司的医疗损失率(MLR)低于规定的阈值，将对其进行处罚。MLR粗略地衡量为医疗保健费用与参保人支付的保费之比。我调查是否有mlr和保险公司提供的护理质量之间的关系。方法:利用保险公司和市场固定效应的回归分析，采用10年的市场层面财务数据和质量变量样本，以及相关的控制变量。结果:在15项质量测量中，只有一项与MLR有统计学显著关系。对于这个测量，关系是负的。结论:虽然MLR条款可能会为保险公司降低保费提供激励，但本样本并不表明可能对质量产生有益影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

本刊更多论文

The Patient Protection and Affordable Care Act's provisions regarding medical loss ratios and quality: evidence from Texas.

Objectives: The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies.

Methods: I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects.

Results: Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative.

Conclusions: Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Health Care Finance Medicine-Health Policy

CiteScore

1.70

自引率

0.00%

发文量

期刊介绍： The Journal of Health Care Finance is the only quarterly journal devoted solely to helping you meet your facility"s financial goals. Each issue targets a key area of health care finance. Stay alert to new trends, opportunities, and threats. Make easier, better decisions, with advice from industry experts. Learn from the experiences of other health care organizations. Experts in the field share their experiences on successful programs, proven strategies, practical management tools, and innovative alternatives. The Journal covers today"s most complex dollars-and-cents issues, including hospital/physician contracts, alternative delivery systems, generating maximum margins under PPS.