Wallace Neal T, McConnell K John, Gallia Charles A, Edlund Tina D
Division of Public Administration, Mark O. Hatfield School of Government, Portland State University, P.O. Box 751, 506 SW Mill St., Portland, OR 97207-0751, USA.
J Health Care Poor Underserved. 2010 Nov;21(4):1382-94. doi: 10.1353/hpu.2010.0944.
Oregon's Medicaid program experienced a dramatic decrease in its non-categorically eligible adult members after implementing a new benefit policy in February 2003 for these beneficiaries. The policy included four main elements: premium increases for some enrollees; a more stringent premium payment policy; elimination of some benefits, including mental health and substance abuse treatment; and, the imposition of co-payments. The study compared monthly disenrollment rates eight months before and after the policy change. The new premium payment policy was found to be the main driver of disenrollment, followed by benefit elimination. Premium increases and co-payments had limited impact. Disenrollment was particularly high among vulnerable beneficiary groups, including people with no reported income, those previously obtaining premium waivers, methadone users, and other enrollees with substance abuse conditions. Better understanding of the relationship between benefit design and retention in public health insurance programs could help avoid the unintended policy effects experienced in Oregon.
2003年2月，俄勒冈州的医疗补助计划针对非特定合格成年参保人实施了一项新的福利政策，之后该计划的此类参保人数大幅减少。该政策包含四个主要内容：提高部分参保人的保费；实行更严格的保费支付政策；取消部分福利，包括心理健康和药物滥用治疗；以及实施共付额。该研究比较了政策变更前后八个月的每月退保率。结果发现，新的保费支付政策是退保的主要驱动因素，其次是福利取消。保费提高和共付额的影响有限。在弱势受益人群体中，退保率尤其高，包括无收入申报者、此前获得保费豁免者、美沙酮使用者以及其他有药物滥用情况的参保人。更好地理解福利设计与公共医疗保险计划参保率之间的关系，有助于避免俄勒冈州所经历的意外政策影响。
