Eichner J, Kahn J G
National Academy of Social Insuarance, USA.
Medicare Brief. 2001 Aug(8):1-10.
Because Medicare does not cover a large part of the health care that its enrollees living with HIV/AIDS require, they need other coverage to supplement Medicare. Medicaid is a major source of that supplemental coverage. In California, Medicare enrollees with HIV/AIDS who were also enrolled in Medi-Cal (California's Medicaid program) had total payments from both programs of $177 million, or an average of $28,956 per person in the fee-for-service-system in 1998. Of that total, Medicare paid for 38 percent, mainly for inpatient visits and ambulatory care, while Medi-Cal paid 62 percent, mainly for prescription drugs. For these dual enrollees, many of Medicare's benefit gaps--including a large share of prescription drugs, nursing facility services and home care--are being filled by Medi-Cal. Data in this Medicare Brief indicate that the incremental cost to the federal government of filling gaps in the Medicare benefits package would be considerably less than the full cost of the additional benefits. Through Medicaid and other programs, the federal government is already paying a substantial part of public program expenditures for dual enrollees with HIV/AIDS. Other issues to consider are how the dual Medicare-Medicaid funding streams affect the programs' cost efficiency, and from the perspective of Medicare enrollees and providers, how well the dual programs coordinate to meet the needs of people with HIV/AIDS and other chronic conditions.
由于医疗保险并不涵盖其艾滋病毒/艾滋病参保者所需的大部分医疗保健服务，他们需要其他保险来补充医疗保险。医疗补助是这种补充保险的一个主要来源。在加利福尼亚州，同时参加医疗补助计划（加利福尼亚州的医疗补助项目）的艾滋病毒/艾滋病医疗保险参保者，在1998年按服务收费系统计算，这两个项目的总支付额为1.77亿美元，人均平均为28,956美元。在这笔总额中，医疗保险支付了38%，主要用于住院就诊和门诊护理，而医疗补助支付了62%，主要用于处方药。对于这些双重参保者来说，医疗保险的许多福利缺口——包括很大一部分处方药、护理机构服务和家庭护理——正由医疗补助来填补。本医疗保险简报中的数据表明，填补医疗保险福利套餐缺口给联邦政府带来的增量成本将远低于额外福利的全部成本。通过医疗补助和其他项目，联邦政府已经为艾滋病毒/艾滋病双重参保者支付了公共项目支出的很大一部分。其他需要考虑的问题是，医疗保险与医疗补助的双重资金流如何影响项目的成本效率，以及从医疗保险参保者和提供者的角度来看，这两个双重项目在满足艾滋病毒/艾滋病患者和其他慢性病患者需求方面的协调程度如何。
