医疗保险健康维护组织参保者的医疗保健使用情况及支出
Health care use and expenditures of Medicare HMO disenrollees.
作者信息
Parente Stephen T, Evans William N, Schoenman Julie A, Finch Michael D
机构信息
University of Minnesota, Department of Finance, Carlson School of Management, Minneapolis 55455, USA.
出版信息
Health Care Financ Rev. 2005 Spring;26(3):31-43.
We examine the impact of the first wave of Medicare health maintenance organization HMO withdrawals. With data from CMS and United Health Group, we estimate use and expenditure changes between 1998 and 1999 for HMO enrollees who were involuntarily dropped from their plan and returned to fee-for-service (FFS) Medicare using a difference-in-difference model. Compared to those who voluntarily left an HMO, involuntarily disenrolled beneficiaries had higher out-of-pocket expenditures, an 80 percent decrease in physician visits, 38 percent higher emergency room (ER) use and a higher probability of dying. The results suggest beneficiaries face significant costs and reduced health outcomes from unstable Medicare managed care markets.
我们研究了医疗保险健康维护组织（HMO）首次撤资浪潮的影响。利用医疗保险和医疗补助服务中心（CMS）以及联合健康集团的数据，我们采用双重差分模型估计了1998年至1999年期间，那些被非自愿地从其医疗保险组织计划中剔除并转回按服务收费（FFS）医疗保险的参保人的医疗服务使用情况和支出变化。与那些自愿离开医疗保险组织的人相比，非自愿退出的受益人自付费用更高，看诊次数减少了80%，急诊室（ER）就诊次数增加了38%，死亡概率更高。研究结果表明，受益人因医疗保险管理式医疗市场不稳定而面临巨大成本，并导致健康状况下降。
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