Laugesen Miriam J, Paul Rebecca R, Luft Harold S, Aubry Wade, Ganiats Theodore G
Department of Health Services, UCLA School of Public Health, 31-293A CHS, Box 1772, Los Angeles, CA 90095-1772, USA.
Health Serv Res. 2006 Jun;41(3 Pt 2):1081-103. doi: 10.1111/j.1475-6773.2006.00521.x.
To understand and compare the trends in mandated benefits laws in the United States.
DATA SOURCES/STUDY SETTING: Mandated benefit laws enacted in 50 states and the District of Columbia for the period 1949-2002 were compiled from multiple published compendia.
Laws that require private insurers and health plans to cover particular services, types of diseases, or care by specific providers in 50 states and the District of Columbia are compared for the period 1949-2002. Legislation is compared by year, by average and total frequency, by state, by type (provider, health care service, or preventive), and according to whether it requires coverage or an offer of coverage.
DATA COLLECTION/EXTRACTION METHOD: Data from published tables were entered into a spreadsheet and analyzed using statistical software.
A total of 1,471 laws mandated coverage for 76 types of providers and services. The most common type of mandated coverage is for specific health care services (670 laws for 34 different services), followed by laws for services offered by specific professionals and other providers (507 mandated benefits laws for 25 types of providers), and coverage for specific preventive services (295 laws for 17 benefits). On average, a mandated benefit law has been adopted or significantly revised by 19 states, and each state has approximately 29 mandates. Only two benefits (minimum maternity stay and breast reconstruction) are mandated in all 51 jurisdictions and these were also federally mandated benefits. The mean number of total mandated benefit laws adopted or significantly revised per year was 17 per year in the 1970s, 36 per year in the 1980s, 59 per year in the 1990s, and 76 per year between 2000 and 2002. Since 1990, mandate adoption increased substantially, with around 55 percent of all mandated benefit laws enacted between 1990 and 2002.
There was a large increase in the number of mandated benefits laws during the managed care "backlash" of the 1990s. Many states now use mandated benefits to prescribe not only what services and benefits would be provided but how, where, and when services will be provided.
了解并比较美国强制保险福利法的发展趋势。
数据来源/研究背景：1949年至2002年期间，美国50个州和哥伦比亚特区颁布的强制保险福利法汇编自多个已发表的汇编资料。
对1949年至2002年期间，要求私人保险公司和健康计划涵盖特定服务、疾病类型或特定提供者所提供护理的50个州和哥伦比亚特区的法律进行比较。按年份、平均频率和总频率、州、类型（提供者、医疗服务或预防服务）以及是否要求承保或提供承保来比较立法情况。
数据收集/提取方法：将已发表表格中的数据录入电子表格，并使用统计软件进行分析。
共有1471项法律规定了76种类型的提供者和服务的承保范围。最常见的强制承保类型是特定医疗服务（针对34种不同服务的670项法律），其次是针对特定专业人员和其他提供者提供的服务的法律（针对25种类型提供者的507项强制保险福利法），以及特定预防服务的承保范围（针对17种福利的295项法律）。平均而言，19个州通过或大幅修订了一项强制保险福利法，每个州约有29项规定。在所有51个司法管辖区中，只有两项福利（最低产假和乳房重建）是强制规定的，而且这些也是联邦强制规定的福利。20世纪70年代，每年通过或大幅修订的强制保险福利法的平均总数为17项，80年代为每年36项，90年代为每年59项，2000年至2002年期间为每年76项。自1990年以来，强制规定的采用大幅增加，1990年至2002年期间颁布的所有强制保险福利法中约有55%。
在20世纪90年代管理式医疗的“反弹”期间，强制保险福利法的数量大幅增加。现在，许多州不仅使用强制保险福利来规定提供哪些服务和福利，还规定服务的提供方式、地点和时间。
