Biles Brian, Hersch Nicholas Lauren, Cooper Barbara S, Adrion Emily, Guterman Stuart
Department of Health Policy, George Washington University School of Public Health and Health Services, USA.
Issue Brief (Commonw Fund). 2006 Nov;23:1-16.
The Medicare Modernization Act of 2003 sharply increased payments to private Medicare Advantage plans. As a result, every plan in every county in the nation was paid more in 2005 than its enrollees would have been expected to cost if they had been enrolled in traditional fee-for-service Medicare. The authors calculate that payments to Medicare Advantage plans averaged 12.4 percent more than costs in traditional Medicare during 2005: a total of more than $5.2 billion, or $922 for each of the 5.6 million Medicare enrollees in managed care. This issue brief updates an earlier analysis of Medicare Advantage payments in 2005 previously published by The Commonwealth Fund; the updated estimates in this report are based on final 2005 enrollment figures that were not available at the time the previous estimates were developed, and they include the effect of policy decisions that were not reflected in the previous estimates.
2003年的《医疗保险现代化法案》大幅提高了对私人医疗保险优势计划的支付。结果，2005年全国每个县的每个计划获得的支付都高于其参保人若参加传统按服务收费的医疗保险预计所需的费用。作者计算得出，2005年医疗保险优势计划的支付平均比传统医疗保险的成本高出12.4%：总计超过52亿美元，即560万参加管理式医疗的医疗保险参保人中每人922美元。本问题简报更新了英联邦基金会此前发布的对2005年医疗保险优势计划支付情况的早期分析；本报告中的最新估计基于2005年最终参保数据，这些数据在之前估计时不可用，且包括之前估计未反映的政策决定的影响。
