Long Sharon K, Yemane Alshadye
Urban Institute in Washington, DC, USA.
Health Aff (Millwood). 2005 Jul-Aug;24(4):1084-94. doi: 10.1377/hlthaff.24.4.1084.
Although the rapid increase in Medicaid managed care during the early 1990s attracted commercial plans to the program, by the late 1990s commercial plan participation in Medicaid had begun to decline. This study examines the role of Medicaid policies, plan characteristics, and local health care market conditions in a commercial plan's decision to exit. We find that many of the factors that influence commercial plans' decisions to exit Medicaid are within the control of state policymakers and program administrators, including capitation rates, service carve-outs, mandatory enrollment policies, and the number of Medicaid enrollees and areas served by the plan.
尽管20世纪90年代初医疗补助管理式医疗的迅速增长吸引了商业保险公司参与该项目，但到90年代末，商业保险公司参与医疗补助的比例已开始下降。本研究考察了医疗补助政策、保险公司特征以及当地医疗市场状况在商业保险公司退出决策中的作用。我们发现，影响商业保险公司退出医疗补助决策的许多因素都在州政策制定者和项目管理者的控制范围内，包括人头费率、服务分拆、强制参保政策，以及该保险公司服务的医疗补助参保人数和地区数量。
