University of Massachusetts Boston, USA.
Med Care Res Rev. 2011 Dec;68(6):712-24. doi: 10.1177/1077558711409048. Epub 2011 May 19.
This study analyzes administrative impediments to enrollment in HEALTHpact, a high-deductible plan with premiums capped at 10% of the average Rhode Island wage. HEALTHpact includes an opportunity for enrollees to reduce their deductibles from $5,000 ($10,000 for a family) to $750 ($1,500 for a family) if they engage in prespecified wellness behaviors. A stakeholder panel was convened to develop guidelines for insurers, which, in turn, were required to develop products satisfying those guidelines. Implementation was examined using stakeholder interviews and archival documents. Results indicate that since no funds were allocated for education and monitoring, there was little opportunity to promote "bottom up" demand or to oversee insurers. They also indicate that both insurers and brokers adopted strategies that inhibited take-up. Providing the resources necessary for effective government oversight and outreach will be critical to small group market reform nationally. So too will be promoting broker and insurer buy-in.
本研究分析了 HEALTHpact 参保的行政障碍，这是一种高免赔额计划，保费上限为罗德岛平均工资的 10%。HEALTHpact 为参保人提供了一个机会，如果他们参与规定的健康行为，将免赔额从 5000 美元（家庭为 10000 美元）降低到 750 美元（家庭为 1500 美元）。一个利益相关者小组被召集来为保险公司制定指导方针，而保险公司则需要根据这些指导方针开发产品。使用利益相关者访谈和档案文件来检查实施情况。结果表明，由于没有分配资金用于教育和监测，因此几乎没有机会促进“自下而上”的需求或监督保险公司。它们还表明，保险公司和经纪人都采取了抑制参保的策略。为有效监管和外展提供必要的资源对于全国小型团体市场改革至关重要。同样重要的是促进经纪人与保险公司的认同。
