Normand Sharon-Lise T, Belanger Albert J, Frank Richard G
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
J Behav Health Serv Res. 2003 Jan-Feb;30(1):78-92. doi: 10.1007/BF02287814.
In the absence of adequate risk adjustment, capitation for enrollees creates incentives for health plans to enroll and retain good risks and to avoid bad risks. This article examines whether Maryland Medicaid beneficiaries with histories of substance abuse disenroll from health plans more frequently than those without such histories. The findings indicate that enrollees with a history of substance abuse were more likely to switch plans than other enrollees, regardless of whether they chose the health plan or were randomly assigned to the plan. These results suggest that current risk-adjustment systems may fail to offset selection incentives in modern capitated health plans.
在缺乏充分风险调整的情况下，为参保人提供按人头付费会促使健康保险计划去招募并留住健康风险低的人群，同时规避健康风险高的人群。本文研究了有药物滥用史的马里兰州医疗补助受益人是否比没有此类病史的受益人更频繁地退出健康保险计划。研究结果表明，有药物滥用史的参保人比其他参保人更有可能更换保险计划，无论他们是自行选择该健康保险计划还是被随机分配到该计划。这些结果表明，当前的风险调整系统可能无法抵消现代按人头付费健康保险计划中的选择激励因素。
