Hall Mark A
Wake Forest University School of Law, USA.
Issue Brief (Commonw Fund). 2011 May;7:1-12.
To achieve the aims of the Affordable Care Act, state and federal regulators must construct an effective system of risk adjustment, one that protects health insurers that attract a disproportionate share of patients with poor health risks. This brief, which summarizes a Commonwealth Fund–supported conference of leading risk adjustment experts, explores the challenges regulators will face, considers the consequences of the law's risk adjustment provisions, and analyzes the merits of different risk adjustment strategies. Among other recommendations, the brief suggests that regulators use diagnostic rather than only demographic risk measures, that they allow states some but limited flexibility to tailor risk adjustment methods to local circumstances, and that they phase in the use of risk transfer payments to give insurers more time to predict and understand the full effects of risk adjustment.
为实现《平价医疗法案》的目标，州和联邦监管机构必须构建一个有效的风险调整体系，该体系要保护那些吸引了健康风险不佳患者比例过高的健康保险公司。本简报总结了英联邦基金会支持的一次主要风险调整专家会议，探讨了监管机构将面临的挑战，考虑了该法律风险调整条款的后果，并分析了不同风险调整策略的优点。除其他建议外，简报还建议监管机构使用诊断性而非仅基于人口统计学的风险衡量标准，允许各州有一定但有限的灵活性，以便根据当地情况调整风险调整方法，并逐步引入风险转移支付，以便保险公司有更多时间预测和理解风险调整的全部影响。
