Gold Marsha, Achman Lori, Brown Randall
Manag Care Q. 2003 Winter;11(1):24-33.
The MedicareChoice program was created to expand choice and encourage beneficiaries to more actively consider the choices they have. This article assesses how "salient" choice is to Medicare beneficiaries. More than half of all Medicare beneficiaries in 2000 reported that they either have never considered their options to join a Medicare HMO or get supplemental coverage (44 percent) or did so last when they first became Medicare eligible (14 percent). Overall, 14 percent of Medicare beneficiaries found choice salient in 2000. Those new to Medicare or forced to switch because their plan left the program were more likely to consider choice, as expected. The multi-variate analysis shows that existing HMO enrollment is most strongly associated with salience of choice and also that this effect operates especially in the individual market. The findings of this research are consistent with the literature in highlighting the limited salience of choice to Medicare beneficiaries and the even more limited extent of actual switching that occurs in that market. There is little reason to believe that choice is more salient now than when the study was done. Policymakers who seek to encourage market-based solutions confront a dilemma: How to create incentives for a choice that most beneficiaries do not find particularly salient.
“医疗保险选择”计划旨在扩大选择范围，并鼓励受益人更积极地考虑自身所拥有的选择。本文评估了“选择”对于医疗保险受益人的“显著程度”。2000年，超过半数的医疗保险受益人表示，他们要么从未考虑过加入医疗保险健康维护组织（HMO）或获得补充保险的选择（44%），要么上一次考虑这些选择是在首次符合医疗保险资格的时候（14%）。总体而言，2000年有14%的医疗保险受益人认为选择很显著。正如预期的那样，刚加入医疗保险的人或因原计划退出该项目而被迫更换计划的人更有可能考虑选择。多变量分析表明，现有的健康维护组织参保情况与选择的显著程度关联最为紧密，而且这种影响在个人市场中尤为明显。本研究结果与相关文献一致，都强调了选择对于医疗保险受益人的显著程度有限，以及该市场中实际发生的更换计划的情况更为有限。几乎没有理由相信现在的选择比研究进行时更显著。寻求鼓励基于市场的解决方案的政策制定者面临一个困境：如何为大多数受益人并不特别看重的选择创造激励措施。
