University of California, Los Angeles, USA.
J Health Polit Policy Law. 2010 Dec;35(6):961-97. doi: 10.1215/03616878-2010-035.
The Medicare prescription drug benefit relies on private insurers. In most states, there are nearly fifty competing insurance plans available. The sheer number of choices makes it extremely difficult for Medicare beneficiaries, many of whom must cope with declining cognitive abilities, to choose the best plan for themselves. This article proposes an alternative to the current system, where government acts as a broker to winnow the number of choices so that beneficiaries face a small subset of those judged to be best on several dimensions. The study is based on three case studies where government has acted as such a broker. Two are from health (Medicaid's system of competitive bidding in Arizona, and a Medicare demonstration project on selective contracting for medical equipment and supplies), and one from the pension field (so-called 457 plans). The case studies were used to help evaluate the proposal based on competition, choice, quality, simplicity, and stability. We conclude that the proposal meets most of the positive features embodied in these five evaluation criteria. Consideration of this idea can ultimately result in a Medicare prescription drug benefit that best serves the needs of Medicare beneficiaries.
医疗保险处方药福利依赖于私人保险公司。在大多数州，有近五十个相互竞争的保险计划可供选择。选择的数量之多，使得许多认知能力下降的医疗保险受益人极难为自己选择最佳计划。本文提出了一种替代当前系统的方法，即政府充当经纪人，以减少选择的数量，使受益人只需面对少数被认为在多个方面是最佳的选择。该研究基于政府充当此类经纪人的三个案例研究。其中两个来自医疗保健领域（亚利桑那州医疗补助计划的竞标系统，以及医疗保险针对医疗设备和用品的选择性合同的试点项目），一个来自养老金领域（所谓的 457 计划）。这些案例研究被用于根据竞争、选择、质量、简单性和稳定性来帮助评估该提案。我们的结论是，该提案符合这五个评估标准所体现的大多数积极特征。考虑这一想法最终可以使医疗保险处方药福利能够更好地满足医疗保险受益人的需求。
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