Hadley Jack, Holahan John
Urban Institute,Washington, DC 20037, USA.
Inquiry. 2003 Winter;40(4):323-42. doi: 10.5034/inquiryjrnl_40.4.323.
This paper addresses the question of whether Medicaid is in fact a high-cost program after adjusting for the health of the people it covers. We compare and simulate annual per capita medical spending for lower-income people (families with incomes under 200% of poverty) covered for a full year by either Medicaid or private insurance. We first show that low-income privately insured enrollees and Medicaid enrollees have very different socioeconomic and health characteristics. We then present simulated comparisons based on multivariate statistical models that estimate the effects of private and Medicaid coverage on the likelihood of using services, and the level of expenditures, given any use, holding constant demographic, economic, and health status characteristics. The simulations demonstrate that if people with Medicaid coverage--with their health status, disability, and chronic conditions--were given private coverage, they would cost considerably more than they do today. Conversely, if the privately insured were given Medicaid coverage, spending would be lower. We find no evidence that spending differences between Medicaid and private coverage for low-income people are due to lower service use by Medicaid beneficiaries. We conclude that most of the difference in expenditures is due to differences in provider payment rates.
本文探讨了在对医疗补助计划（Medicaid）所覆盖人群的健康状况进行调整之后，该计划是否实际上是一个高成本项目的问题。我们比较并模拟了由医疗补助计划或私人保险全年覆盖的低收入人群（收入低于贫困线200%的家庭）的人均年度医疗支出。我们首先表明，低收入的私人保险参保者和医疗补助计划参保者具有非常不同的社会经济和健康特征。然后，我们基于多变量统计模型进行模拟比较，这些模型估计了在给定人口统计学、经济和健康状况特征不变的情况下，私人保险和医疗补助计划覆盖对使用服务的可能性以及支出水平的影响。模拟结果表明，如果享有医疗补助计划覆盖的人群——考虑到他们的健康状况、残疾情况和慢性病状况——获得私人保险，他们的花费将比目前大幅增加。相反，如果私人保险参保者获得医疗补助计划覆盖，支出将会降低。我们没有发现证据表明低收入人群中医疗补助计划和私人保险之间的支出差异是由于医疗补助计划受益者使用服务较少所致。我们得出结论，支出差异的主要原因在于医疗服务提供者支付费率的不同。
