Biles Brian, Pozen Jonah, Guterman Stuart
Department of Health Policy, School of Public Health and Health Services, The George Washington University.
Issue Brief (Commonw Fund). 2009 Aug;65:1-12.
Private health plans that enroll Medicare beneficiaries--known as Medicare Advantage (MA) plans--are being paid $11 billion more in 2009 than it would cost to cover these beneficiaries in regular fee-for-service Medicare. To generate Medicare savings for offsetting the costs of health reform, the Obama Administration has proposed eliminating these extra payments to private insurers and instituting a competitive bidding system that pays MA plans based on the bids they submit. This study examines the concentration of enrollment among MA plans and the degree to which firms offering MA plans actually face competition. The results show that in the large majority of U.S. counties, MA plan enrollment is highly concentrated in a small number of firms. Given the relative lack of competition in many markets as well as the potential impact on traditional Medicare, the authors call for careful consideration of a new system for setting MA plan payments.
吸纳医疗保险受益人的私人健康计划——即所谓的医疗保险优势（MA）计划——在2009年获得的支付比按照常规按服务收费的医疗保险模式覆盖这些受益人所需的成本多出110亿美元。为了节省医疗保险开支以抵消医疗改革的成本，奥巴马政府提议取消向私人保险公司的这些额外支付，并建立一个竞争性投标系统，根据MA计划提交的投标来支付费用。本研究考察了MA计划中的参保集中度，以及提供MA计划的公司实际面临竞争的程度。结果显示，在美国绝大多数县，MA计划的参保高度集中于少数几家公司。鉴于许多市场相对缺乏竞争以及对传统医疗保险的潜在影响，作者呼吁谨慎考虑一种设定MA计划支付的新系统。
