Dowd B, Christianson J, Feldman R, Wisner C, Klein J
School of Public Health, Division of Health Services Research and Policy, University of Minnesota, Minneapolis 55455-0392.
Milbank Q. 1992;70(3):423-53.
The failures of the market for current Medicare health plans include poor information and price distortions and can be attributed to government policy. Reforms that could improve its structure are annual open enrollment periods, premium rebates from health management organizations (HMOs) to members, and termination of the federal government's subsidy of Medicare supplementary insurance. However, the price for a basic Medicare benefits package would still be distorted because Medicare bases its contribution on the cost of a comparable package in the fee-for-service (FFS) sector rather than on the cost of the most efficient plan available to beneficiaries in each market area. The present Medicare HMO program almost certainly increases total Medicare costs and actually discourages HMO growth by shielding beneficiaries from the true price difference between basic benefits in the HMO and FFS sectors. Lacking payment reforms, the Medicare HMO program should be terminated.
当前医疗保险健康计划市场的失灵包括信息不足和价格扭曲，这可归因于政府政策。能够改善其结构的改革措施包括年度开放注册期、健康管理组织（HMO）向成员提供保费回扣，以及终止联邦政府对医疗保险补充保险的补贴。然而，基本医疗保险福利套餐的价格仍会被扭曲，因为医疗保险的缴费是基于按服务收费（FFS）部门中可比套餐的成本，而非基于每个市场区域内受益人可获得的最有效计划的成本。当前的医疗保险HMO计划几乎肯定会增加医疗保险的总成本，而且实际上通过使受益人免受HMO和FFS部门基本福利之间真实价格差异的影响，抑制了HMO的发展。由于缺乏支付改革，医疗保险HMO计划应予终止。
