Biles Brian, Adrion Emily, Guterman Stuart
Department of Health Policy, School of Public Health and Health Services, The George Washington University, USA.
Issue Brief (Commonw Fund). 2008 Oct;48:1-12.
Like the private managed care plans offered under Medicare Advantage, private fee-for-service (PFFS) plans are paid more per beneficiary than those individuals would be expected to cost if they were enrolled in traditional fee-for-service Medicare. However, PFFS plans are not required to provide the same type of coordinated care required of Medicare Advantage plans. Payments to PFFS plans in 2008 average 16.6 percent more than costs in traditional Medicare, or $1,248 for each of the 2 million enrollees in PFFS plans-a total of nearly $2.5 billion in extra payments. Recently, Congress has made significant revisions to policies that will affect how PFFS plans will operate in 2011 and thereafter, as well as their prospects for continued growth. This issue brief examines the development of PFFS plans, the policies underlying the rapid increase in the plans and their enrollment, the payments they receive, and the potential impact of the new legislation.
与医疗保险优势计划下提供的私人管理式医疗保健计划一样，私人按服务收费（PFFS）计划每位受益人的支付额高于这些人若参加传统按服务收费医疗保险预计所需的费用。然而，PFFS计划无需提供医疗保险优势计划所要求的那种协调护理。2008年向PFFS计划的支付平均比传统医疗保险的成本高出16.6%，即PFFS计划中200万参保人中每人1248美元，总计额外支付近25亿美元。最近，国会对政策进行了重大修订，这将影响PFFS计划在2011年及之后的运营方式及其持续增长的前景。本问题简报审视了PFFS计划的发展、计划及其参保人数迅速增加背后的政策、它们获得的支付以及新立法的潜在影响。
