Batavia A I, DeJong G
School of Policy and Management, College of Health and Urban Affairs, Florida International University, North Miami, Florida, USA.
Arch Phys Med Rehabil. 2001 Apr;82(4):546-52. doi: 10.1053/apmr.2001.20829.
As high-cost users of health care, people with disabilities or chronic conditions are particularly vulnerable to risk selection. Preferred risk selection, in which insurers avoid enrolling high-risk people, threatens their access to coverage. Adverse selection, in which high-risk people enroll in the most generous plans, compromises the financial viability of plans that are most responsive to their specific needs. The Americans with Disabilities Act prohibits some forms of risk selection, but does not prevent all disability-based distinctions in insurance practices. From a disability perspective, risk selection must be addressed in a manner that: (1) adequately reflects the health care costs of such individuals; (2) eliminates their need to engage in adverse selection; (3) does not stigmatize them; (4) preserves confidentiality of information; (5) uses substantial outcome measures to ensure quality; and (6) creates market conditions that discourage disability-based discrimination. A risk adjuster based on prior use/expenditures or on a diagnostic indicator sensitive to disability issues may be effective. Failure of reform to address risk selection may threaten the viability of a market-based health care system.
作为医疗保健的高成本使用者，残疾人士或患有慢性疾病的人特别容易受到风险选择的影响。优先风险选择，即保险公司避免招收高风险人群，威胁到他们获得保险的机会。逆向选择，即高风险人群选择最慷慨的保险计划，会损害那些最能满足他们特定需求的保险计划的财务可行性。《美国残疾人法案》禁止某些形式的风险选择，但并不能防止保险业务中所有基于残疾的区别对待。从残疾的角度来看，必须以以下方式解决风险选择问题：(1) 充分反映此类人群的医疗保健成本；(2) 消除他们进行逆向选择的必要性；(3) 不歧视他们；(4) 保护信息的保密性；(5) 使用实质性的结果指标来确保质量；(6) 创造不利于基于残疾的歧视的市场条件。基于既往使用情况/支出或对残疾问题敏感的诊断指标的风险调整器可能会有效。改革未能解决风险选择问题可能会威胁到基于市场的医疗保健系统的可行性。
