Biles Brian, Arnold Grace
Department of Health Policy, Scool of Public Health and Health Services, George Washington University, USA.
Issue Brief (Commonw Fund). 2009 Dec;74:1-12.
The Medicare Advantage (MA) program, which enables Medicare beneficiaries to enjoy private health plan coverage, is a major element of the current health care reform discussion on Capitol Hill--in large part because payments to MA plans in 2009 are expected to run at least $11 billion more than traditional Medicare would have cost. While the pending Senate and House bills both endeavor to reduce these extra MA payments, their approaches are different. The bills also differ on other aspects of reforming the MA program, such as plans' allowable geographic areas, their risk-adjustment systems and reporting requirements, their potential bonuses for achieving high-quality care and providing good management, and their beneficiary protections. This issue brief compares the above and other provisions in the House and Senate bills, which have a common overall goal to improve the value that Medicare obtains for the dollars it spends
“医保优势”(MA)计划使医疗保险受益人能够享受私人健康保险覆盖范围,是目前国会山关于医疗保健改革讨论的一个主要内容——很大程度上是因为预计2009年向MA计划支付的费用将比传统医疗保险的成本至少多出110亿美元。虽然参议院和众议院悬而未决的法案都力图减少这些额外的MA支付,但它们的方法有所不同。这些法案在改革MA计划的其他方面也存在差异,比如计划允许的地理区域、风险调整系统和报告要求、实现高质量护理和提供良好管理的潜在奖金以及对受益人的保护。本问题简报比较了众议院和参议院法案中的上述及其他条款,这些条款有一个共同的总体目标,即提高医疗保险资金的使用价值。