Watson-Wyatt Worldwide, Arlington, Virginia, USA.
Health Aff (Millwood). 2010 Jan-Feb;29(1):156-64. doi: 10.1377/hlthaff.2009.0060. Epub 2009 Dec 3.
This paper compares health plans currently available on the individual market with employer-sponsored plans. Points of comparison include the scope of benefits, cost-sharing provisions, premiums, expected out-of-pocket costs, and actuarial value. We draw from the 2007 KFF/HRET Health Benefits Survey, our own survey of individual-market plans, the MarketScan medical claims database, and a computer simulation of medical claims. We find that in 2007, employment-based plans covered 80 percent of all charges paid by the plan and the member, while individual plans covered 64 percent. For most people, premiums and out-of-pocket costs were more affordable in tax-advantaged employer plans than in individual-market plans. Proposed health reforms would fundamentally alter the plan offerings available to Americans, particularly those offered in the individual market.
本文比较了目前在个人市场上提供的健康计划和雇主赞助的计划。比较点包括福利范围、成本分担条款、保费、预期自付费用和精算价值。我们参考了 2007 年 KFF/HRET 健康福利调查、我们自己的个人市场计划调查、MarketScan 医疗索赔数据库以及医疗索赔的计算机模拟。我们发现，2007 年，就业为基础的计划覆盖了计划和成员支付的所有费用的 80%，而个人计划覆盖了 64%。对于大多数人来说，保费和自付费用在税收优惠的雇主计划中比在个人市场计划中更负担得起。拟议的医疗改革将从根本上改变向美国人提供的计划选择，特别是在个人市场中提供的计划。
