Biles Brian, Dallek Geraldine, Nicholas Lauren Hersch
Department of Health Policy, George Washington University, Washington, DC, USA.
Health Aff (Millwood). 2004 Jul-Dec;Suppl Web Exclusives:W4-586-97. doi: 10.1377/hlthaff.w4.586.
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expands the role of private health plans in Medicare through prescription drug plans and a revised Medicare+Choice (M+C), renamed Medicare Advantage, program. This paper discusses the factors responsible for the failure of M+C to develop as intended in 1997 and analyzes the challenges for MMA implementation in light of these factors. They include making a complex program understandable to beneficiaries; addressing plans' efforts to avoid enrolling high-cost beneficiaries; ensuring stability of benefits, providers, and plans; dealing with beneficiaries enrolled in unsuitable plans; providing equity of health benefits throughout the country; and controlling overall Medicare costs.
2003年的《医疗保险处方药、改进与现代化法案》（MMA）通过处方药计划以及修订后的“医疗保险加选择计划”（M+C，后更名为“医疗保险优势计划”）扩大了私人健康计划在医疗保险中的作用。本文讨论了导致1997年“医疗保险加选择计划”未能按预期发展的因素，并根据这些因素分析了实施MMA所面临的挑战。这些因素包括让受益人理解复杂的计划；应对计划方避免招收高成本受益人的举措；确保福利、医疗服务提供者和计划的稳定性；处理参保于不合适计划的受益人；在全国范围内提供公平的健康福利；以及控制医疗保险的总体成本。
