Bellows Nicole M, Halpin Helen Ann, McMenamin Sara B
Center for Health and Public Policy Studies, University of California-Berkeley, Berkeley, CA 94720-7360, USA.
Health Serv Res. 2006 Jun;41(3 Pt 2):1104-23. doi: 10.1111/j.1475-6773.2006.00522.x.
To determine which states have laws that require the review of mandated health insurance benefits and describe the various approaches states take in reviewing mandated benefits, as stated in the mandated benefit review (MBR) laws.
We queried online databases of the individual state statutes and reviewed the state statutes and state legislative agendas for all 50 states and Washington, DC to identify those states with active MBR laws as of September 2004.
We reviewed the identified MBR laws to catalog their various components. The components chosen for this analysis include: general review strategy, designated reviewers, time frame for conducting reviews, criteria used in the review, requirements to use actuaries, sources of funding, and state data collection systems. Two of the authors independently created analysis categories and coded the MBR laws to document details on the major components of the laws.
We identified 26 state MBR laws active as of September 2004. A majority of the MBR laws specified a prospective review approach and only one law used an exclusively retrospective review approach. A substantial amount of variation was found with regards to the designated reviewers, time frames for conducting reviews, and criteria used in the review. Few states specified the use of actuaries, sources of funding, and state data collection systems.
The number of states that have enacted MBR laws has increased substantially in recent years, however, different states have structured the review of mandated benefits differently, according to the values and perceived needs of the state legislatures. It is important that states increasingly consider a broader scope of review criteria so state decision makers can position themselves to mandate only those benefits that add real value to the state's health care system.
确定哪些州有要求对法定医疗保险福利进行审查的法律，并描述各州在审查法定福利时所采取的各种方法，如法定福利审查（MBR）法律中所述。
我们查询了各州法规的在线数据库，并审查了所有50个州以及华盛顿特区的州法规和州立法议程，以确定截至2004年9月有现行MBR法律的州。
我们审查了已确定的MBR法律，以梳理其各个组成部分。本次分析所选择的组成部分包括：一般审查策略、指定审查人员、进行审查的时间框架、审查中使用的标准、使用精算师的要求、资金来源以及州数据收集系统。两位作者独立创建了分析类别，并对MBR法律进行编码，以记录法律主要组成部分的详细信息。
我们确定截至2004年9月有26项州MBR法律有效。大多数MBR法律规定了前瞻性审查方法，只有一项法律采用了完全回顾性审查方法。在指定审查人员、进行审查的时间框架以及审查中使用的标准方面存在大量差异。很少有州规定使用精算师、资金来源和州数据收集系统。
近年来，颁布MBR法律的州数量大幅增加，然而，根据州立法机构的价值观和感知需求，不同州对法定福利审查的结构有所不同。各州越来越有必要考虑更广泛的审查标准范围，以便州决策者能够只强制要求那些真正为该州医疗保健系统增加价值的福利。
