Dobson DaVanzo and Associates LLC in Vienna, Virginia, USA.
Health Aff (Millwood). 2009 Nov-Dec;28(6):w1013-24. doi: 10.1377/hlthaff.28.6.w1013. Epub 2009 Sep 15.
Two key health reform bills in the House of Representatives and Senate include the option of a "public plan" as an additional source of health coverage. At least initially, the plan would primarily be structured to cover many of the uninsured and those who now have individual coverage. Because it is possible, and perhaps even likely, that this new public payer would pay less than private payers for the same services, such a plan could negatively affect hospital margins. Hospitals may attempt to recoup losses by shifting costs to private payers. We outline the financial pressures that hospitals and private payers could experience under various assumptions. High uninsured enrollment in a public plan would bolster hospital margins; however, this effect is reversed if the privately insured enter a public plan in large proportions, potentially stressing the hospital industry and increasing private insurance premiums.
众议院和参议院的两项关键医疗改革法案都包含了“公共计划”作为额外医疗保险来源的选项。至少在最初阶段，该计划主要是为了覆盖许多未参保者和那些现在有个人保险的人。由于这个新的公共支付者可能会为相同的服务支付低于私人支付者的费用，因此这样的计划可能会对医院的利润率产生负面影响。医院可能会试图通过向私人支付者转移成本来弥补损失。我们根据各种假设概述了医院和私人支付者可能面临的财务压力。高比例的未参保者加入公共计划会增加医院的利润率；但是，如果大量的私人保险参保者也加入公共计划，这种影响就会逆转，这可能会给医院行业带来压力，并增加私人保险保费。
