Pracht Etienne E
University of South Florida, USA.
J Health Polit Policy Law. 2007 Aug;32(4):685-731. doi: 10.1215/03616878-2007-022.
The objective of this article is to understand the political motivations underlying Medicaid managed care reforms by examining the determinants of enrollment of beneficiaries in managed care plans in the fifty states. To highlight the role of the model variables, including measures of the political environment, public interest, and special interests, a distinction is made between capitated and fee-for-service managed care enrollment. The results show that cost containment within the context of the Medicaid program is perceived as strongly favored by voters. Accordingly, the relative cost and tax price of providing Medicaid services are important factors in states' decision to enroll Medicaid beneficiaries in managed care plans, particularly capitated ones. The results also indicate a surprisingly significant influence by labor unions that generally oppose managed care enrollment for fears of lost jobs. The recipient population and provider groups also play an important role in shaping the Medicaid managed care landscape. The influence of variables measuring states' ability and willingness to pay and median voter preferences suggest that, within the context of Medicaid managed care enrollment, the public's interests are being served; however, the results also point toward inequities within the program and implications concerning financing arrangements between states and the federal government.
本文的目的是通过研究五十个州医疗补助管理式医疗计划受益人的参保决定因素，来理解医疗补助管理式医疗改革背后的政治动机。为突出模型变量的作用，包括政治环境、公共利益和特殊利益的衡量指标，对按人头付费和按服务收费的管理式医疗参保情况进行了区分。结果表明，选民强烈支持在医疗补助计划范围内控制成本。因此，提供医疗补助服务的相对成本和税收价格是各州决定让医疗补助受益人参加管理式医疗计划，特别是按人头付费计划的重要因素。结果还显示，工会有着惊人的显著影响力，工会通常因担心失业而反对参保。受助人群体和提供者群体在塑造医疗补助管理式医疗格局方面也发挥着重要作用。衡量各州支付能力和意愿以及中位选民偏好的变量的影响表明，在医疗补助管理式医疗参保的背景下，公众利益得到了维护；然而，结果也指向了该计划内的不公平现象以及各州与联邦政府之间融资安排的影响。
